Healthcare Provider Details

I. General information

NPI: 1912998030
Provider Name (Legal Business Name): JASON PAUL HILLMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 CHATHAM SQUARE OFFICE PARK
FREDERICKSBURG VA
22405-2561
US

IV. Provider business mailing address

PO BOX 3039
FREDERICKSBURG VA
22402-3039
US

V. Phone/Fax

Practice location:
  • Phone: 540-374-5200
  • Fax: 540-374-1164
Mailing address:
  • Phone: 540-374-5200
  • Fax: 540-374-1164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102201700
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200500055
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: