Healthcare Provider Details

I. General information

NPI: 1255437240
Provider Name (Legal Business Name): HILDE JERIUS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 11/17/2022
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 S 4TH ST FL 2
LEBANON PA
17042-6111
US

IV. Provider business mailing address

200 CLINIC DR
MADISONVILLE KY
42431-1661
US

V. Phone/Fax

Practice location:
  • Phone: 717-270-3751
  • Fax: 717-270-3754
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number39560
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number39560
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD442906
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: