Provider Demographics
NPI:1215990155
Name:BANBURY, JILLIAN E (MD)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:E
Last Name:BANBURY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0249
Mailing Address - Country:US
Mailing Address - Phone:302-654-1341
Mailing Address - Fax:
Practice Address - Street 1:3710 KENNETT PIKE
Practice Address - Street 2:SUITE 400A
Practice Address - City:GREENVILLE
Practice Address - State:DE
Practice Address - Zip Code:19807-2157
Practice Address - Country:US
Practice Address - Phone:302-888-0508
Practice Address - Fax:302-888-0509
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074473B208200000X
DEC10008018208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHG91436Medicare UPIN
OH2111217Medicare ID - Type Unspecified