Provider Demographics
NPI:1639274921
Name:LILLY, MELISSA (PA)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:LILLY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 AMHERST ST STE 2B
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2841
Mailing Address - Country:US
Mailing Address - Phone:540-536-8000
Mailing Address - Fax:
Practice Address - Street 1:1880 AMHERST ST STE 300
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2808
Practice Address - Country:US
Practice Address - Phone:540-536-8000
Practice Address - Fax:540-536-8000
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY503394OtherANTHEM
1070140OtherCERTIFICATION NATIONAL CO
1070140OtherCERTIFICATION NATIONAL CO