Provider Demographics
NPI:1699063750
Name:WILFORD, JILLIAN LEE (MD)
Entity type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:LEE
Last Name:WILFORD
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 1:11 HUNT CLUB PLZ
Mailing Address - Street 2:
Mailing Address - City:RIDGELEY
Mailing Address - State:WV
Mailing Address - Zip Code:26753-5213
Mailing Address - Country:US
Mailing Address - Phone:304-726-4501
Mailing Address - Fax:
Practice Address - Street 1:97 ADMINISTRATIVE DR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-6378
Practice Address - Country:US
Practice Address - Phone:304-350-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV25193207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program