Basic Information
| Provider Information | |||||||||
| NPI: | 1023049053 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STUDLEY | ||||||||
| FirstName: | JILL | ||||||||
| MiddleName: | LOUISE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5730 EXECUTIVE DR STE 230 | ||||||||
| Address2: | |||||||||
| City: | CATONSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212281762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722328080 | ||||||||
| FaxNumber: | 8002819558 | ||||||||
| Practice Location | |||||||||
| Address1: | 8000 FRANKFORD RD | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752526834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722328080 | ||||||||
| FaxNumber: | 9722328099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 02/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | L4738 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0300X | 2020-03905 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207RG0300X | L4738 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8S3697 | 01 | TX | BCBS | OTHER | 1515496-02 | 05 | TX | MEDICAID | 8X0054 | 01 | TX | BCBS | OTHER | 1515496-03 | 05 | TX | MEDICAID |