Healthcare Provider Details

I. General information

NPI: 1336119783
Provider Name (Legal Business Name): LILLIAN MARIE DECOSIMO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 N OCEAN BLVD APT 706
LAUDERDALE BY THE SEA FL
33308-3018
US

IV. Provider business mailing address

5200 N OCEAN BLVD APT 706
LAUDERDALE BY THE SEA FL
33308-3018
US

V. Phone/Fax

Practice location:
  • Phone: 703-859-5225
  • Fax: 844-898-2182
Mailing address:
  • Phone: 703-859-5225
  • Fax: 844-898-2182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME131219
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101053044
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: