Healthcare Provider Details

I. General information

NPI: 1427163427
Provider Name (Legal Business Name): LILIA GOROVITS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9867 B BUSTLETON AVE BUSTLETON HEALTH CARE
PHILADELPHIA PA
19115-2611
US

IV. Provider business mailing address

1157 METTLER RD
HUNT VALLEY PA
19006-1909
US

V. Phone/Fax

Practice location:
  • Phone: 215-698-9295
  • Fax: 215-698-0127
Mailing address:
  • Phone: 215-698-9295
  • Fax: 215-698-0127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD061228L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: