Provider Demographics
NPI:1649258765
Name:LILLY, TIMOTHY J (DO)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:LILLY
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:432 HILLCREST AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-1708
Mailing Address - Country:US
Mailing Address - Phone:724-615-9193
Mailing Address - Fax:724-458-6689
Practice Address - Street 1:432 HILLCREST AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-1708
Practice Address - Country:US
Practice Address - Phone:724-615-9193
Practice Address - Fax:724-458-6689
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2017-01-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS006328L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011775800010Medicaid
PA0011775800010Medicaid