Provider Demographics
NPI:1275572695
Name:HILTZ, DEBORAH J (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:J
Last Name:HILTZ
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:PO BOX 1112
Mailing Address - Street 2:1322 LOCUST AVE
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554
Mailing Address - Country:US
Mailing Address - Phone:304-366-0700
Mailing Address - Fax:304-366-9529
Practice Address - Street 1:1322 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554
Practice Address - Country:US
Practice Address - Phone:304-366-0700
Practice Address - Fax:304-366-9529
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18269208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV370017785OtherRR MEDICARE
WVD64640OtherWV WORKER'S COMP
WV001718663OtherMT SATE BC/BS
WV0109780000Medicaid
WV206702OtherCARELINK
WV0004068724OtherAETNA
WVFQ18269-AOtherHEALTH PLAN
WV4251211OtherMEDICARE PTAN
WV550486849 0056OtherCIGNA
WV0573002OtherHOME PLAN PEIA AND CHIPS
WV505815OtherNATIONAL CAPITAL PPO
WV550486849 0056OtherCIGNA
WVFQ18269-AOtherHEALTH PLAN