Healthcare Provider Details

I. General information

NPI: 1215920178
Provider Name (Legal Business Name): LILLIAN MARIE CARDONA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date: 03/27/2006
Reactivation Date: 04/04/2006

III. Provider practice location address

19735 GERMANTOWN RD SUITE 100
GERMANTOWN MD
20874-1214
US

IV. Provider business mailing address

19735 GERMANTOWN RD SUITE 100
GERMANTOWN MD
20874-1214
US

V. Phone/Fax

Practice location:
  • Phone: 301-917-6513
  • Fax: 301-917-6501
Mailing address:
  • Phone: 301-917-6513
  • Fax: 301-917-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD46930
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: