Provider Demographics
NPI:1437241262
Name:LILAVIVAT, USAH (MD)
Entity Type:Individual
Prefix:DR
First Name:USAH
Middle Name:
Last Name:LILAVIVAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 W WESMARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-1900
Mailing Address - Country:US
Mailing Address - Phone:803-469-7500
Mailing Address - Fax:803-469-7519
Practice Address - Street 1:635 W WESMARK BLVD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1900
Practice Address - Country:US
Practice Address - Phone:803-469-7500
Practice Address - Fax:803-469-7519
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10500207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC105004Medicaid
SC105004Medicaid