Provider Demographics
NPI:1932438322
Name:LILLY, ROBERTA (MD , MPH)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:
Last Name:LILLY
Suffix:
Gender:F
Credentials:MD , MPH
Other - Prefix:DR
Other - First Name:ROBERTA
Other - Middle Name:
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:219 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-2913
Mailing Address - Country:US
Mailing Address - Phone:410-822-1000
Mailing Address - Fax:410-820-7949
Practice Address - Street 1:219 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-2913
Practice Address - Country:US
Practice Address - Phone:410-822-1000
Practice Address - Fax:410-820-7949
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168057208600000X
PAMD041923-E208600000X
CO27401204F00000X
DCMD036920208600000X
MDD0070090208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC211730YT2Medicare PIN