Provider Demographics
NPI:1962482711
Name:LILLIE, MADELINE A (MD)
Entity Type:Individual
Prefix:DR
First Name:MADELINE
Middle Name:A
Last Name:LILLIE
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 1:500 CORPORATE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1263
Mailing Address - Country:US
Mailing Address - Phone:716-631-0380
Mailing Address - Fax:716-631-3229
Practice Address - Street 1:500 CORPORATE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1263
Practice Address - Country:US
Practice Address - Phone:716-631-0380
Practice Address - Fax:716-631-3229
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145777207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00614475Medicaid
NY00614475Medicaid