Healthcare Provider Details

I. General information

NPI: 1497741961
Provider Name (Legal Business Name): CHRIS T. HILLMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 08/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 SEWALL ST
PORTLAND ME
04102-2603
US

IV. Provider business mailing address

PO BOX 1260
PORTLAND ME
04104-1260
US

V. Phone/Fax

Practice location:
  • Phone: 207-828-2100
  • Fax: 207-828-2190
Mailing address:
  • Phone: 207-828-2100
  • Fax: 207-828-2190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA184
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: