Provider Demographics
NPI:1558445379
Name:HILLIARD, TERESA LEAH (DPM)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:LEAH
Last Name:HILLIARD
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 QUACKENBOS ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-1229
Mailing Address - Country:US
Mailing Address - Phone:301-390-4440
Mailing Address - Fax:202-726-0656
Practice Address - Street 1:5632 ANNAPOLIS RD STE 12
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-2213
Practice Address - Country:US
Practice Address - Phone:301-390-4440
Practice Address - Fax:202-726-0656
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA103000906213E00000X
MD01129213E00000X
DCPO517213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC011297300Medicaid
DC011297300Medicaid
DC5812240001Medicare NSC