Provider Demographics
NPI:1477948248
Name:MUNDY, LILY RUTH (MD)
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:RUTH
Last Name:MUNDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:410-933-6423
Mailing Address - Fax:410-500-4266
Practice Address - Street 1:601 N CAROLINE ST # 8161
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0006
Practice Address - Country:US
Practice Address - Phone:443-997-9466
Practice Address - Fax:410-614-4333
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2023-03-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD94276208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery