Provider Demographics
NPI:1295834786
Name:HILLER, CONSTANCE ROGERSON (MD)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:ROGERSON
Last Name:HILLER
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 1:13 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02912-9006
Mailing Address - Country:US
Mailing Address - Phone:401-863-3953
Mailing Address - Fax:401-863-7953
Practice Address - Street 1:13 BROWN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02912-9006
Practice Address - Country:US
Practice Address - Phone:401-863-3953
Practice Address - Fax:401-863-7953
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD08522208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics