MEDICARE: DR. LILLIAN MARIE DECOSIMO M.D.

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	207V00000X	Obstetrics & Gynecology Physician	ME131219	FL
2	174400000X	Specialist	0101053044	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336119783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LILLIAN MARIE DECOSIMO M.D.

Provider Business Mailing Address
First Line	:	5200 N OCEAN BLVD APT 706
Second Line	:
City	:	LAUDERDALE BY THE SEA
State	:	FL
Zip	:	33308-3018
Country	:	US
Telephone Number	:	703-859-5225
Fax Number	:	844-898-2182

Provider Business Practice Location Address
First Line	:	5200 N OCEAN BLVD APT 706
Second Line	:
City	:	LAUDERDALE BY THE SEA
State	:	FL
Zip	:	33308-3018
Country	:	US
Telephone Number	:	703-859-5225
Fax Number	:	844-898-2182

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	09/04/2025

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Directions to “ DR. LILLIAN MARIE DECOSIMO M.D.” Practice Location

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