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General NPI Number Information
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NPI Number | 1548214687
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Entity Type | Individual
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Provider Name | LAWRENCE EDWARD TILLEY M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 12/28/2007
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Provider Practice Location Address
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Address Line | 23000 MOAKLEY ST #203
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City | LEONARDTOWN
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State | MD
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Zip | 20650-2915
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Country | US
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Telephone | 301-475-8599
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Fax | 301-475-1514
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Provider Business Mailing Address
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Address Line | 23000 MOAKLEY ST #203
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City | LEONARDTOWN
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State | MD
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Zip | 20650-2915
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Country | US
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Telephone | 301-475-8599
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Fax | 301-475-1514
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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 | D28647
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License Number State | MD
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