Provider Demographics
NPI:1790878890
Name:HYLTON, CONNIE (MD)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:HYLTON
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 215
Mailing Address - Street 2:
Mailing Address - City:LOW MOOR
Mailing Address - State:VA
Mailing Address - Zip Code:24457-0215
Mailing Address - Country:US
Mailing Address - Phone:540-862-6898
Mailing Address - Fax:540-862-6899
Practice Address - Street 1:1 ARH LANE
Practice Address - Street 2:SUITE 103 B
Practice Address - City:LOW MOOR
Practice Address - State:VA
Practice Address - Zip Code:24457
Practice Address - Country:US
Practice Address - Phone:540-862-6898
Practice Address - Fax:540-862-6899
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD429964207R00000X
VA0101242786207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD429964OtherMEDICAL LICENSE
VA0101242786OtherLICENSE