Provider Demographics
NPI:1518296615
Name:HILES, LIZA (MD)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:
Last Name:HILES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LIZA
Other - Middle Name:DAWN
Other - Last Name:WINEBRENNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:351 N PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21750-1046
Mailing Address - Country:US
Mailing Address - Phone:301-790-9044
Mailing Address - Fax:301-790-9490
Practice Address - Street 1:351 N PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MD
Practice Address - Zip Code:21750-1046
Practice Address - Country:US
Practice Address - Phone:301-678-2901
Practice Address - Fax:240-752-6000
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-18
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV25899207Q00000X
MDD0075448207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine