Provider Demographics
NPI:1316056161
Name:MIDTHUNE, JILL B (MD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:B
Last Name:MIDTHUNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:B
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED SCHOOL UNDERGRAD
Mailing Address - Street 1:6535 N CHARLES ST
Mailing Address - Street 2:STE 300
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-5826
Mailing Address - Country:US
Mailing Address - Phone:410-938-5252
Mailing Address - Fax:410-938-5250
Practice Address - Street 1:6535 N CHARLES ST
Practice Address - Street 2:STE 300
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-5826
Practice Address - Country:US
Practice Address - Phone:410-938-5252
Practice Address - Fax:410-938-5250
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD413192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD157711500Medicaid
MD157711500Medicaid
E82408Medicare UPIN