Basic Information
| Provider Information | |||||||||
| NPI: | 1821079625 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LADD | ||||||||
| FirstName: | JILL | ||||||||
| MiddleName: | JAYSON | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11850 W MARKET PL | ||||||||
| Address2: | SUITE P | ||||||||
| City: | FULTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207592670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013408339 | ||||||||
| FaxNumber: | 2404855407 | ||||||||
| Practice Location | |||||||||
| Address1: | 2301 RESEARCH BLVD | ||||||||
| Address2: | SUITE 215 | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208503204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014243444 | ||||||||
| FaxNumber: | 3019260655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2005 | ||||||||
| LastUpdateDate: | 01/11/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | D0022868 | MD | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VG0400X | D0022868 | MD | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 526691200 | 05 | MD | MEDICAID |