Provider Demographics
NPI:1952322950
Name:MCCONNELL, LILA TERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:LILA
Middle Name:TERESA
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5530 WISCONSIN AVE
Mailing Address - Street 2:SUITE 1445
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815
Mailing Address - Country:US
Mailing Address - Phone:301-634-1346
Mailing Address - Fax:240-330-4275
Practice Address - Street 1:5530 WISCONSIN AVE
Practice Address - Street 2:SUITE 1445
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815
Practice Address - Country:US
Practice Address - Phone:301-634-1346
Practice Address - Fax:240-330-4275
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD39456207R00000X
DC12657207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C88473Medicare UPIN
110223376Medicare ID - Type Unspecified