Provider Demographics
NPI:1225065121
Name:KHOURY, LILY E (MD)
Entity Type:Individual
Prefix:MRS
First Name:LILY
Middle Name:E
Last Name:KHOURY
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 1:404 HUTTLESTON AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719
Mailing Address - Country:US
Mailing Address - Phone:508-996-9333
Mailing Address - Fax:508-996-3443
Practice Address - Street 1:404 HUTTLESTON AVE
Practice Address - Street 2:
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719
Practice Address - Country:US
Practice Address - Phone:508-996-9333
Practice Address - Fax:508-996-3443
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA36346208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9785302Medicaid
MA2023008Medicaid
MA9785302Medicaid