Provider Demographics
NPI:1821331695
Name:GAVRILOVICH, LILLIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LILLIAN
Middle Name:
Last Name:GAVRILOVICH
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 1:1009 UNION CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-1114
Mailing Address - Country:US
Mailing Address - Phone:703-759-3609
Mailing Address - Fax:
Practice Address - Street 1:1009 UNION CHURCH RD
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-1114
Practice Address - Country:US
Practice Address - Phone:703-759-3609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-31
Last Update Date:2013-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101024334207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine