Provider Demographics
NPI:1336252808
Name:BLESCIA, JILL S (MD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:S
Last Name:BLESCIA
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 1:1414 9TH AVE
Mailing Address - Street 2:STATION MEDICAL CENTER
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-2415
Mailing Address - Country:US
Mailing Address - Phone:814-946-1655
Mailing Address - Fax:814-949-7616
Practice Address - Street 1:1414 9TH AVE
Practice Address - Street 2:STATION MEDICAL CENTER
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-2415
Practice Address - Country:US
Practice Address - Phone:814-946-1655
Practice Address - Fax:814-949-7616
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428539208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1018245870001Medicaid
PAI66651Medicare UPIN