Healthcare Provider Details

I. General information

NPI: 1255788535
Provider Name (Legal Business Name): LILA M MARTIN MD,MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 CAMPUS DR STE 1
SCARBOROUGH ME
04074-7164
US

IV. Provider business mailing address

96 CAMPUS DR STE 1
SCARBOROUGH ME
04074-7164
US

V. Phone/Fax

Practice location:
  • Phone: 78-859-9005
  • Fax: 207-396-5600
Mailing address:
  • Phone: 78-859-9005
  • Fax: 207-396-5600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number266942
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD25742
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number24466
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: