Provider Demographics
NPI:1609849694
Name:RABASSA, JILL L (MD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:L
Last Name:RABASSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:L
Other - Last Name:NEEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-1354
Mailing Address - Fax:704-384-1374
Practice Address - Street 1:1918 RANDOLPH RD
Practice Address - Street 2:SUITE 275
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1100
Practice Address - Country:US
Practice Address - Phone:704-384-1354
Practice Address - Fax:704-384-1374
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC99-01270207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN01276Medicaid
NC89129W0Medicaid
NCH07765Medicare UPIN
SCN01276Medicaid