Provider Demographics
NPI:1245325729
Name:STILLION, TERESA HAWKINS (MD)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:HAWKINS
Last Name:STILLION
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:MARGARET
Other - Last Name:HAWKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:436 CLAIRMONT COURT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834
Mailing Address - Country:US
Mailing Address - Phone:804-526-2121
Mailing Address - Fax:804-520-2617
Practice Address - Street 1:436 CLAIRMONT COURT
Practice Address - Street 2:SUITE 100
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834
Practice Address - Country:US
Practice Address - Phone:804-526-2121
Practice Address - Fax:804-520-2617
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD16461207Q00000X
NC2018-02747207Q00000X
IN01081424A207Q00000X
TXS0803207Q00000X
VA0101056263207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G59812Medicare UPIN