Provider Demographics
NPI:1255788535
Name:MARTIN, LILA M (MD,MPH)
Entity type:Individual
Prefix:
First Name:LILA
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 CAMPUS DR STE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7164
Mailing Address - Country:US
Mailing Address - Phone:078-859-9005
Mailing Address - Fax:207-396-5600
Practice Address - Street 1:96 CAMPUS DR STE 1
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7164
Practice Address - Country:US
Practice Address - Phone:078-859-9005
Practice Address - Fax:207-396-5600
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA266942207R00000X
NH24466207RI0011X
MEMD25742207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMD25742OtherLICENSE