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General NPI Number Information
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NPI Number | 1336119783
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Entity Type | Individual
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Provider Name | LILLIAN MARIE DECOSIMO M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/26/2006
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 5200 N OCEAN BLVD APT 706
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City | LAUDERDALE BY THE SEA
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State | FL
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Zip | 33308-3018
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Country | US
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Telephone | 703-859-5225
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Fax | 844-898-2182
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Provider Business Mailing Address
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Address Line | 5200 N OCEAN BLVD APT 706
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City | LAUDERDALE BY THE SEA
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State | FL
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Zip | 33308-3018
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Country | US
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Telephone | 703-859-5225
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Fax | 844-898-2182
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME131219
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0101053044
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License Number State | VA
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