Basic Information
| Provider Information | |||||||||
| NPI: | 1912998030 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HILLMAN | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3039 | ||||||||
| Address2: | |||||||||
| City: | FREDERICKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224023039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403745200 | ||||||||
| FaxNumber: | 5403741164 | ||||||||
| Practice Location | |||||||||
| Address1: | 418 CHATHAM SQUARE OFFICE PARK | ||||||||
| Address2: | |||||||||
| City: | FREDERICKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224052561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403745200 | ||||||||
| FaxNumber: | 5403741164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2005 | ||||||||
| LastUpdateDate: | 07/10/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0102201700 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 200500055 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1912998030 | 05 | VA | MEDICAID | NC1070 | 05 | SC | MEDICAID | 5913008 | 05 | NC | MEDICAID | 1912998030 | 05 | NC | MEDICAID |