Provider Demographics
NPI:1467727750
Name:LILO, MOHAMMED TAREQ (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:TAREQ
Last Name:LILO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:ONE MEDICAL CENTER DR
Mailing Address - Street 2:DHMC DEPARTMENT OF PATHOLOGY
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-0001
Mailing Address - Country:US
Mailing Address - Phone:603-650-9485
Mailing Address - Fax:
Practice Address - Street 1:1122 AUSTIN HWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-4844
Practice Address - Country:US
Practice Address - Phone:210-342-6488
Practice Address - Fax:210-342-6725
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXR7054207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program