Provider Demographics
NPI:1558709345
Name:W. LIMA, M.D., P.A.
Entity Type:Organization
Organization Name:W. LIMA, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WEERASAK
Authorized Official - Middle Name:W
Authorized Official - Last Name:LIMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-561-2424
Mailing Address - Street 1:1905 YORK RD
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4224
Mailing Address - Country:US
Mailing Address - Phone:410-561-2424
Mailing Address - Fax:410-252-1342
Practice Address - Street 1:1905 YORK RD
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-4224
Practice Address - Country:US
Practice Address - Phone:410-561-2424
Practice Address - Fax:410-252-1342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD23262174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD974731100Medicaid
MD1982677688OtherNPI
MD5407OtherMEDICARE PTEN