Provider Demographics
NPI:1770515983
Name:WHITE, JILL R (MD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:R
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:ERIN
Other - Last Name:RYDQUIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3824 NORTHERN PIKE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2141
Mailing Address - Country:US
Mailing Address - Phone:412-457-0060
Mailing Address - Fax:
Practice Address - Street 1:310 RODI RD
Practice Address - Street 2:STE 140
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-3318
Practice Address - Country:US
Practice Address - Phone:412-371-6414
Practice Address - Fax:412-371-9739
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD064480L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001683314Medicaid
103041OtherVPMC HEALTH PLAN
370010592OtherRAILROAD MEDICARE
5257636OtherAETNA
678052OtherBLUE SHIELD
P001106OtherGATEWAY HEALTH PLAN
G64277Medicare UPIN
103041OtherVPMC HEALTH PLAN
G64277Medicare UPIN