MEDICARE: DR. ELIZABETH ANN LILLY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	D05627	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952340549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH ANN LILLY M.D.

Provider Business Mailing Address
First Line	:	1306 EVA GUDE DR
Second Line	:
City	:	CROWNSVILLE
State	:	MD
Zip	:	21032-2102
Country	:	US
Telephone Number	:	301-261-8598
Fax Number	:	301-261-8168

Provider Business Practice Location Address
First Line	:	1306 EVA GUDE DR
Second Line	:
City	:	CROWNSVILLE
State	:	MD
Zip	:	21032-2102
Country	:	US
Telephone Number	:	301-261-8598
Fax Number	:	301-261-8168

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	12/13/2007

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