Provider Demographics
NPI:1205853793
Name:TILLINGHAST, GUY W (MD)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:W
Last Name:TILLINGHAST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:860 OMNI BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4430
Mailing Address - Country:US
Mailing Address - Phone:757-232-8769
Mailing Address - Fax:757-232-8875
Practice Address - Street 1:12100 WARWICK BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-2365
Practice Address - Country:US
Practice Address - Phone:757-534-5555
Practice Address - Fax:757-534-5566
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101231733174400000X
MEMD21709207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1205853793Medicaid
VAP00261371Medicare PIN
VAH53415Medicare UPIN
VA1205853793Medicaid