Healthcare Provider Details

I. General information

NPI: 1740685908
Provider Name (Legal Business Name): JILLIAN MAGEE MARDEN PA-C, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILLIAN MAGEE SMITH PA-C, RD

II. Dates (important events)

Enumeration Date: 10/30/2014
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 UNION PARK RD UNIT 8
TOPSHAM ME
04086-1711
US

IV. Provider business mailing address

178 SEA MEADOWS LN
YARMOUTH ME
04096-5527
US

V. Phone/Fax

Practice location:
  • Phone: 204-200-5907
  • Fax: 207-544-5157
Mailing address:
  • Phone: 207-200-5907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPAN1949
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberNU3720
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: