Provider Demographics
NPI:1922323435
Name:OTOLORIN, LILY O (MD)
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:O
Last Name:OTOLORIN
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 4212
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22194-4212
Mailing Address - Country:US
Mailing Address - Phone:646-593-6787
Mailing Address - Fax:
Practice Address - Street 1:2337 KEW GARDENS DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-6577
Practice Address - Country:US
Practice Address - Phone:646-593-6787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI53928208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI53928OtherWI STATE LIC