Healthcare Provider Details

I. General information

NPI: 1356791388
Provider Name (Legal Business Name): LILLY ANN YI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER BLVD POB 1,SUITE 205
CHESTER PA
19013-3902
US

IV. Provider business mailing address

1 MEDICAL CENTER BLVD POB 1,SUITE 205
CHESTER PA
19013-3902
US

V. Phone/Fax

Practice location:
  • Phone: 610-619-7410
  • Fax: 610-876-8483
Mailing address:
  • Phone: 610-619-7410
  • Fax: 610-876-8483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMT211956
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: