MEDICARE: LILY GRAINGER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1326997925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILY GRAINGER

Provider Business Mailing Address
First Line	:	555 PRESIDENT ST UNIT 1405
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21202-6060
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8600 SNOWDEN RIVER PKWY STE 207
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-1985
Country	:	US
Telephone Number	:	301-515-2901
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	01/26/2026

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Directions to “ LILY GRAINGER ” Practice Location

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