Healthcare Provider Details

I. General information

NPI: 1326614132
Provider Name (Legal Business Name): LILLIAN SEO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 CHAPMAN ST STE 100
PROVIDENCE RI
02905-4539
US

IV. Provider business mailing address

180 CORLISS ST STE E1
PROVIDENCE RI
02904-2602
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-6118
  • Fax: 401-444-8804
Mailing address:
  • Phone: 401-793-2928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD20731
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD20731
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: