Healthcare Provider Details

I. General information

NPI: 1932438322
Provider Name (Legal Business Name): ROBERTA LILLY M.D. , M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROBERTA HALL M.D.

II. Dates (important events)

Enumeration Date: 12/14/2009
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 S WASHINGTON ST
EASTON MD
21601-2913
US

IV. Provider business mailing address

219 S WASHINGTON ST
EASTON MD
21601-2913
US

V. Phone/Fax

Practice location:
  • Phone: 410-822-1000
  • Fax: 410-820-7949
Mailing address:
  • Phone: 410-822-1000
  • Fax: 410-820-7949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number27401
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number168057
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD041923-E
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD036920
License Number StateDC
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD0070090
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: