Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 0101039785 | VA |
NPI | 1265430052 |
---|---|
Provider Name | Dr. Paul Krehl Stillwagon |
First Address | Skyland, NC 28776-2076 |
Second Address | Winchester, VA 22601-6365 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2005 |
Last Update Date | 17/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001717682 | MOUNTAIN STATE BC/BS (01) | VA |
001717682 | MOUNTAIN STATE BC/BS (01) | WV |
006082602 | (05) | VA |
0070369000 | (05) | WV |
032685 | ANTHEM BC/BS (01) | VA |
A72567 | (02) | |
VVI896A | MEDICARE PTAN (01) | VA |