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NPI Code Detail

MEDICARE: JOHN RICHARD LILLY MD

MEDICARE: JOHN RICHARD 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
1207Q00000XFamily Medicine PhysicianD09357MD

General Provider Information

NPI Number : 1528051711
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN RICHARD LILLY MD
Provider Business Mailing Address
First Line : 5804 BALTIMORE AVE
Second Line :
City : HYATTSVILLE
State : MD
Zip : 20781-1623
Country : US
Telephone Number : 301-927-7800
Fax Number : 301-927-0375
Provider Business Practice Location Address
First Line : 5804 BALTIMORE AVE
Second Line :
City : HYATTSVILLE
State : MD
Zip : 20781-1623
Country : US
Telephone Number : 301-927-7800
Fax Number : 301-927-0375
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2005
Last Update Date : 02/22/2016

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Directions to “ JOHN RICHARD LILLY MD” Practice Location

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