Provider Demographics
NPI:1992714042
Name:COLVIN, JILL H (MD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:H
Last Name:COLVIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5717
Mailing Address - Country:US
Mailing Address - Phone:207-623-6680
Mailing Address - Fax:207-623-6609
Practice Address - Street 1:6 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5717
Practice Address - Country:US
Practice Address - Phone:207-623-6680
Practice Address - Fax:207-623-6609
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI41818207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE400191210Medicare PIN
WI33349800Medicaid
BC6627054OtherDEA NUMBER