Healthcare Provider Details

I. General information

NPI: 1225919376
Provider Name (Legal Business Name): DR. LILIA DEBORJA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 EDMONDSON AVE STE 204
BALTIMORE MD
21229-1614
US

IV. Provider business mailing address

4200 EDMONDSON AVE STE 204
BALTIMORE MD
21229-1614
US

V. Phone/Fax

Practice location:
  • Phone: 410-624-0037
  • Fax: 410-947-2794
Mailing address:
  • Phone: 410-624-0037
  • Fax: 410-947-2794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LILIA DEBORJA
Title or Position: DOCTOR
Credential:
Phone: 410-456-9551