Healthcare Provider Details

I. General information

NPI: 1841284650
Provider Name (Legal Business Name): ANN PHILOMENA ZILLIOX M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 07/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11835 FISHING POINT DR SUITE 107
NEWPORT NEWS VA
23606-2584
US

IV. Provider business mailing address

860 OMNI BLVD STE 303
NEWPORT NEWS VA
23606-4477
US

V. Phone/Fax

Practice location:
  • Phone: 757-873-3882
  • Fax: 757-873-2269
Mailing address:
  • Phone: 757-232-8769
  • Fax: 757-232-8875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number0101-42444
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: