Healthcare Provider Details

I. General information

NPI: 1073908190
Provider Name (Legal Business Name): JACQUELINE MARIE ZILLIOUX MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 RAY C HUNT DR
CHARLOTTESVILLE VA
22903-2981
US

IV. Provider business mailing address

PO BOX 9007
CHARLOTTESVILLE VA
22906-9007
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-2224
  • Fax: 434-244-9481
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number35.139409
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0101275295
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: