Provider Demographics
NPI:1992728323
Name:KEREKES, JILL MARIE (MD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:KEREKES
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 1:301C US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9701
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:584 ROOSEVELT TRL
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-7302
Practice Address - Country:US
Practice Address - Phone:207-892-3233
Practice Address - Fax:207-893-0752
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD17649207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME200802OtherANTHEM
NH30208309Medicaid
ME432827099Medicaid
ME000439203Medicare PIN
ME200802OtherANTHEM
ME000439204Medicare PIN
ME000439207Medicare PIN
ME000439201Medicare PIN
OHI37978Medicare UPIN
NH30208309Medicaid
ME000439202Medicare PIN
ME432827099Medicaid