Provider Demographics
NPI:1356838213
Name:LILL, ALLEN A JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:A
Last Name:LILL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALLEN
Other - Middle Name:ANDERSON
Other - Last Name:LILL
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3600 FORBES AVE
Mailing Address - Street 2:FORBES TOWER-PLAZA LEVEL SUITE 140
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 HOWARD AVE
Practice Address - Street 2:SUITE F-2
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601
Practice Address - Country:US
Practice Address - Phone:814-889-2020
Practice Address - Fax:814-889-2213
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP422207Q00000X
390200000X
PAMT216744207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program