Provider Demographics
NPI:1164957825
Name:HILLMAN, KATELYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:KATELYNN
Middle Name:
Last Name:HILLMAN
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 1:410 MAPLE AVE W # UNITS56
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4240
Mailing Address - Country:US
Mailing Address - Phone:256-520-9086
Mailing Address - Fax:
Practice Address - Street 1:410 MAPLE AVE W STE 5&6
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4240
Practice Address - Country:US
Practice Address - Phone:703-938-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101269363208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program