Provider Demographics
NPI:1851345524
Name:HILDEBRAND, TERESA A (MD)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:A
Last Name:HILDEBRAND
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 1:1000 SE TECH CENTER DRIVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683
Mailing Address - Country:US
Mailing Address - Phone:360-260-2773
Mailing Address - Fax:360-260-2217
Practice Address - Street 1:1000 SE TECH CENTER DRIVE
Practice Address - Street 2:SUITE 120
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683
Practice Address - Country:US
Practice Address - Phone:360-260-2773
Practice Address - Fax:360-260-2217
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00031170207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8156044Medicaid
AB13856Medicare ID - Type Unspecified
WA8156044Medicaid