Provider Demographics
NPI:1255401501
Name:HILAMAN, BRAD L (MD)
Entity type:Individual
Prefix:MR
First Name:BRAD
Middle Name:L
Last Name:HILAMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 N HOWE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-3038
Mailing Address - Country:US
Mailing Address - Phone:910-457-3806
Mailing Address - Fax:910-457-3842
Practice Address - Street 1:823 N ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461
Practice Address - Country:US
Practice Address - Phone:910-457-9292
Practice Address - Fax:910-457-5269
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500936207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8942452Medicaid
E98423Medicare UPIN
2216041AMedicare ID - Type Unspecified
2330938Medicare ID - Type UnspecifiedGROUP #
NC8942452Medicaid