Provider Demographics
NPI:1851392237
Name:LILIENTHAL, VIRGINIA PITTS (MD)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:PITTS
Last Name:LILIENTHAL
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 1:1920 PALM BEACH LAKES BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-3506
Mailing Address - Country:US
Mailing Address - Phone:561-509-5009
Mailing Address - Fax:561-738-1822
Practice Address - Street 1:13475 SOUTHERN BLVD STE 202
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE GROVES
Practice Address - State:FL
Practice Address - Zip Code:33470-9233
Practice Address - Country:US
Practice Address - Phone:561-798-2468
Practice Address - Fax:561-798-2733
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105916208000000X
KY36561208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001938500Medicaid
KY000000314719OtherBCBS
KY64038334Medicaid