Provider Demographics
NPI:1265900716
Name:HILLIARD JR, STEPHEN VAN JR
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:VAN
Last Name:HILLIARD JR
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10932 W POINT PL
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-3252
Mailing Address - Country:US
Mailing Address - Phone:240-449-5717
Mailing Address - Fax:
Practice Address - Street 1:3110 ESTHER PL SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-1505
Practice Address - Country:US
Practice Address - Phone:202-594-5141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant