MEDICARE: LEONARD STUART LILLY MD

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	207RC0000X	Cardiovascular Disease Physician	44570	MA

General Provider Information

NPI Number	:	1396735528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONARD STUART LILLY MD

Provider Business Mailing Address
First Line	:	1153 CENTRE ST
Second Line	:	SUITE 4930
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-3446
Country	:	US
Telephone Number	:	617-983-7420
Fax Number	:

Provider Business Practice Location Address
First Line	:	1153 CENTRE ST
Second Line	:	SUITE 4930
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-3446
Country	:	US
Telephone Number	:	617-983-7420
Fax Number	:

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

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	08/08/2007

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Directions to “ LEONARD STUART LILLY MD” Practice Location

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