Provider Demographics
NPI:1114974334
Name:OCHOCO-CAVANAUGH, LILLIAN (MD)
Entity Type:Individual
Prefix:MRS
First Name:LILLIAN
Middle Name:
Last Name:OCHOCO-CAVANAUGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5140 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2215
Mailing Address - Country:US
Mailing Address - Phone:412-622-6408
Mailing Address - Fax:412-683-9701
Practice Address - Street 1:5140 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2215
Practice Address - Country:US
Practice Address - Phone:412-622-6408
Practice Address - Fax:412-683-9701
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039126L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0070514220003Medicaid
PAP00660507Medicare PIN
PA064007Medicare PIN
PAE63898Medicare UPIN