Provider Demographics
NPI:1265430052
Name:STILLWAGON, PAUL KREHL (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:KREHL
Last Name:STILLWAGON
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:PO BOX 2076
Mailing Address - Street 2:
Mailing Address - City:SKYLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28776-2076
Mailing Address - Country:US
Mailing Address - Phone:828-575-2644
Mailing Address - Fax:828-350-2174
Practice Address - Street 1:1828 W PLAZA DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6365
Practice Address - Country:US
Practice Address - Phone:540-662-9115
Practice Address - Fax:540-665-0411
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101039785207KA0200X, 207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA032685OtherANTHEM BC/BS
VA006082602Medicaid
WV001717682OtherMOUNTAIN STATE BC/BS
WV0070369000Medicaid
VAVVI896AOtherMEDICARE PTAN
VA001717682OtherMOUNTAIN STATE BC/BS
VA030001087Medicare PIN
WV0609452Medicare PIN
WVP00799958Medicare PIN
VA032685OtherANTHEM BC/BS
WV0070369000Medicaid