Provider Demographics
NPI:1275592206
Name:EMSLANDER, HILDEGARD C (MD)
Entity Type:Individual
Prefix:DR
First Name:HILDEGARD
Middle Name:C
Last Name:EMSLANDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HILDEGARD
Other - Middle Name:C
Other - Last Name:RYAN-EMSLANDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 104240
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65110-4240
Mailing Address - Country:US
Mailing Address - Phone:573-556-7704
Mailing Address - Fax:573-556-1714
Practice Address - Street 1:1241 W STADIUM BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-6023
Practice Address - Country:US
Practice Address - Phone:573-556-7704
Practice Address - Fax:573-556-1714
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO118430208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO284684401Medicaid
MO284684401Medicaid
MO000094511Medicare PIN