Provider Demographics
NPI:1811333180
Name:TILLY, ALYSSA EVELYN (MD)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:EVELYN
Last Name:TILLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5003 OLD CLINIC BUILDING CB# 7550
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7550
Mailing Address - Country:US
Mailing Address - Phone:919-445-6764
Mailing Address - Fax:919-966-9746
Practice Address - Street 1:5003 OLD CLINIC BUILDING CB# 7550
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599
Practice Address - Country:US
Practice Address - Phone:919-445-6764
Practice Address - Fax:919-966-9746
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201700907207RH0002X
NC191519390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program