Basic Information
| Provider Information | |||||||||
| NPI: | 1316942964 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRILLAMAN | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD FACP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5900 LAKE WRIGHT DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235021871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572135700 | ||||||||
| FaxNumber: | 7572135701 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 SENTARA CIRCLE | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 231885727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572292236 | ||||||||
| FaxNumber: | 7572210409 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2005 | ||||||||
| LastUpdateDate: | 09/22/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 0101053122 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 830004889 | 01 | VA | RAILROAD MEDICARE | OTHER | 005815363 | 05 | VA | MEDICAID | 12542 | 01 | VA | OPTIMA | OTHER |