Provider Demographics
NPI:1508941477
Name:MONAHAN, LILA HOSPON (MD)
Entity Type:Individual
Prefix:
First Name:LILA
Middle Name:HOSPON
Last Name:MONAHAN
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:PO BOX 3677
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03061-3677
Mailing Address - Country:US
Mailing Address - Phone:603-577-7900
Mailing Address - Fax:603-577-7972
Practice Address - Street 1:116 SPIT BROOK RD
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-2711
Practice Address - Country:US
Practice Address - Phone:603-891-0083
Practice Address - Fax:603-891-6940
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11818208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30203390Medicaid
NHRE7026Medicare PIN
NH30203390Medicaid