Healthcare Provider Details

I. General information

NPI: 1972532885
Provider Name (Legal Business Name): LILIA LOFRANCO DEBORJA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 EDMONDSON AVENUE SUITE 204
BALTIMORE MD
21229
US

IV. Provider business mailing address

4200 EDMONDSON AVENUE SUITE 204
BALTIMORE MD
21229
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 TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD16970
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0016970
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: