Provider Demographics
NPI:1073565289
Name:PRILLAMAN, BARBARA M (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:M
Last Name:PRILLAMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 WATERCOVE RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-3982
Mailing Address - Country:US
Mailing Address - Phone:804-744-0200
Mailing Address - Fax:
Practice Address - Street 1:3510-A ANDERSON HWY.
Practice Address - Street 2:
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139
Practice Address - Country:US
Practice Address - Phone:804-598-3100
Practice Address - Fax:804-598-2965
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047439207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA540883363OtherCHAMPUS-TRICARE
VA259330OtherANTHEM
VA10530OtherCIGNA
VA540883363OtherFIRST HEALTH/CCN
VA856746OtherMAMSI
VA540883363OtherGREAT WEST HEALTHCARE
VA540883363OtherPREFERRED CARE
VA540883363OtherVIRGINIA HEALTH NETWORK
VA0100412OtherUNITED HEALTHCARE
VA22320OtherOPTIMA
VA5633851Medicaid
VA82534OtherSOUTHERN HEALTH
VA540883363OtherPHCS
VA568498OtherAETNA
VA016209V26Medicare PIN
VA856746OtherMAMSI
VA5633851Medicaid
VA080006616Medicare PIN
VAF62673Medicare UPIN