MEDICARE: DR. PAUL KREHL STILLWAGON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207KA0200X	Allergy Physician	0101039785	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	VVI896A	OTHER	VA	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	032685	OTHER	VA	ANTHEM BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	001717682	OTHER	WV	MOUNTAIN STATE BC/BS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	001717682	OTHER	VA	MOUNTAIN STATE BC/BS

General Provider Information

NPI Number	:	1265430052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL KREHL STILLWAGON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2076
Second Line	:
City	:	SKYLAND
State	:	NC
Zip	:	28776-2076
Country	:	US
Telephone Number	:	828-575-2644
Fax Number	:	828-350-2174

Provider Business Practice Location Address
First Line	:	1828 W PLAZA DR
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22601-6365
Country	:	US
Telephone Number	:	540-662-9115
Fax Number	:	540-665-0411

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	11/17/2015

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Directions to “ DR. PAUL KREHL STILLWAGON M.D.” Practice Location

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