Healthcare Provider Details

I. General information

NPI: 1467719088
Provider Name (Legal Business Name): LILY PIKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 ROYAL LITTLE DR
PROVIDENCE RI
02904-1882
US

IV. Provider business mailing address

1052 PARK AVE
CRANSTON RI
02910-3225
US

V. Phone/Fax

Practice location:
  • Phone: 401-808-6693
  • Fax: 401-654-5319
Mailing address:
  • Phone: 401-461-5056
  • Fax: 401-942-3590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD15934
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberMD15934
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: