Provider Demographics
NPI:1427048297
Name:HILLIS, NANCY (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:HILLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BALA AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-3214
Mailing Address - Country:US
Mailing Address - Phone:215-452-0304
Mailing Address - Fax:215-452-0311
Practice Address - Street 1:25 BALA AVENUE
Practice Address - Street 2:SUITE 102
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004
Practice Address - Country:US
Practice Address - Phone:215-452-0304
Practice Address - Fax:215-452-0311
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD21932208000000X
NJ25MA077765002080P0204X
PAMD421932208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine