Healthcare Provider Details

I. General information

NPI: 1104811645
Provider Name (Legal Business Name): LILLIAN VIRGINIA KRAMAN-ROACH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

846 WALKER RD SUITE 31-2
DOVER DE
19904-2756
US

IV. Provider business mailing address

PO BOX 589
CAMDEN WYOMING DE
19934-0589
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-9188
  • Fax: 302-674-1108
Mailing address:
  • Phone: 302-674-9188
  • Fax: 302-674-1108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC10004688
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: