Basic Information
| Provider Information | |||||||||
| NPI: | 1497738850 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUILLIAN | ||||||||
| FirstName: | WARREN | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1490 PANTOPS MOUNTAIN PL STE 200 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229114601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349794440 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1490 PANTOPS MOUNTAIN PL | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229114601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349794440 | ||||||||
| FaxNumber: | 4349794441 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2005 | ||||||||
| LastUpdateDate: | 07/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0101230928 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 241522 | 01 | VA | ALLIANCE | OTHER | 184379 | 01 | VA | SOUTHERN HEALTH | OTHER | 241522 | 01 | VA | MAMSI | OTHER | 436536 | 01 | VA | ANTHEM | OTHER | 5120089001 | 01 | VA | CIGNA | OTHER | 54493 | 01 | VA | COMMUNITY HEALTH | OTHER |