Healthcare Provider Details

I. General information

NPI: 1518494509
Provider Name (Legal Business Name): EVANGELINE HILLEGASS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EVANGELINE JOSEPH

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4186 CORTLAND DR
NEW PARIS PA
15554-7706
US

IV. Provider business mailing address

4186 CORTLAND DR
NEW PARIS PA
15554-7706
US

V. Phone/Fax

Practice location:
  • Phone: 814-839-4108
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD470640
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: