Individual
HILDE JERIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
252 S 4TH ST FL 2, LEBANON, PA 17042-6111
(717) 270-3751
(717) 270-3754
Mailing address
200 CLINIC DR, MADISONVILLE, KY 42431-1661
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
39560
KY
2086S0129X
Vascular Surgery Physician
39560
KY
2086S0129X
Vascular Surgery Physician
Primary
MD442906
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000371200
BCBS PROVIDER NUMBER
—
05
—
1255437240
—
WI
01
—
39560
LICENSE
KY
05
—
64100571
—
KY
Enumeration date
09/16/2006
Last updated
11/17/2022
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