Healthcare Provider Details

I. General information

NPI: 1558445379
Provider Name (Legal Business Name): TERESA LEAH HILLIARD DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5632 ANNAPOLIS RD STE 12
BLADENSBURG MD
20710-2213
US

IV. Provider business mailing address

615 QUACKENBOS ST NW
WASHINGTON DC
20011-1229
US

V. Phone/Fax

Practice location:
  • Phone: 301-390-4440
  • Fax: 202-726-0656
Mailing address:
  • Phone: 301-390-4440
  • Fax: 202-726-0656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number103000906
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number01129
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO517
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: