Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | D0055269 | MD |
N | 2080A0000X | Adolescent Medicine | D0055269 | MD |
NPI | 1285770214 |
---|---|
Provider Name | Dr. Jill A Pellicoro |
First Address | Upper Marlboro, MD 20772-3670 |
Second Address | Upper Marlboro, MD 20772-3670 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 07/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
407983300 | (05) | MD |