Healthcare Provider Details

I. General information

NPI: 1477990091
Provider Name (Legal Business Name): JILLIAN MATTIONI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2013
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 CREAMERY WAY STE 103
EXTON PA
19341
US

IV. Provider business mailing address

460 CREAMERY WAY STE 103
EXTON PA
19341-2533
US

V. Phone/Fax

Practice location:
  • Phone: 610-384-8300
  • Fax: 610-384-8885
Mailing address:
  • Phone: 610-384-8300
  • Fax: 610-384-8885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberOS019989
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: