Provider Demographics
NPI:1033134044
Name:IM, LILY T (MD)
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:T
Last Name:IM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:419 W REDWOOD ST
Mailing Address - Street 2:SUITE 479
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1734
Mailing Address - Country:US
Mailing Address - Phone:410-328-5918
Mailing Address - Fax:410-328-6346
Practice Address - Street 1:419 W REDWOOD ST
Practice Address - Street 2:SUITE 479
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1734
Practice Address - Country:US
Practice Address - Phone:410-328-5918
Practice Address - Fax:410-328-6346
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-12-14
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Provider Licenses
StateLicense IDTaxonomies
MDD0063550207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I13412Medicare UPIN