Provider Demographics
NPI:1922659176
Name:LILLY, MARCUS ANTHONY
Entity Type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:ANTHONY
Last Name:LILLY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 45TH PL NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-3716
Mailing Address - Country:US
Mailing Address - Phone:202-817-0219
Mailing Address - Fax:
Practice Address - Street 1:906 45TH PL NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-3716
Practice Address - Country:US
Practice Address - Phone:202-817-0219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC557100208OtherKAISER PERMANENTE