Healthcare Provider Details

I. General information

NPI: 1790934115
Provider Name (Legal Business Name): ANNA P LILLIS M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA B PINCHAK M.D., PH.D.

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHILDRENS DR
COLUMBUS OH
43205-2664
US

IV. Provider business mailing address

700 CHILDRENS DR
COLUMBUS OH
43205-2664
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-6200
  • Fax:
Mailing address:
  • Phone: 614-722-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number35.131257
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35.131257
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number35.131257
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: