Provider Demographics
NPI:1952340549
Name:LILLY, ELIZABETH ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN
Last Name:LILLY
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 1:1306 EVA GUDE DR
Mailing Address - Street 2:
Mailing Address - City:CROWNSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21032-2102
Mailing Address - Country:US
Mailing Address - Phone:301-261-8598
Mailing Address - Fax:301-261-8168
Practice Address - Street 1:1306 EVA GUDE DR
Practice Address - Street 2:
Practice Address - City:CROWNSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21032-2102
Practice Address - Country:US
Practice Address - Phone:301-261-8598
Practice Address - Fax:301-261-8168
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD056272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD220791500Medicaid
MD220791500Medicaid