CAVIN, LILLIAN WHITLEY (MD)

Provider Demographics

• NPI: 1952363913
• Name: CAVIN, LILLIAN WHITLEY (MD)
• Entity Type: Individual
• First Name: LILLIAN
• Middle Name: WHITLEY
• Last Name: CAVIN
• Gender: F
• Credentials: MD
• Other - First Name: LILLIAN
• Other - Middle Name: ANN
• Other - Last Name: WHITLEY
• Other - Last Name Type: Former Name
• Other - Credentials: MD
• Mailing Address - Street 1: 22100 BOTHELL EVERETT HWY
• Mailing Address - City: BOTHELL
• Mailing Address - State: WA
• Mailing Address - Zip Code: 98021-8431
• Mailing Address - Country: US
• Mailing Address - Phone: 208-416-2932
• Mailing Address - Fax: 855-673-9190
• Practice Address - Street 1: 5001 EVIDENCE CV
• Practice Address - City: SPICEWOOD
• Practice Address - State: TX
• Practice Address - Zip Code: 78669
• Practice Address - Country: US
• Practice Address - Phone: 855-687-7237
• Practice Address - Fax: 855-673-9190
• Is Sole Proprietor?: No
• Enumeration Date: 2006-04-05
• Last Update Date: 2023-12-05

Provider Licenses

State	License ID	Taxonomies
ID	M9063	2085R0202X
VA	0101235711	2085R0202X
TX	N9181	2085R0202X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	2085R0202X	Allopathic & Osteopathic Physicians	Radiology	Diagnostic Radiology

Provider Identifiers

State	Identifier ID	ID Type	Issuer
VA	3810010472	Medicaid
KY	64130479	Medicaid
PA	1563204	Other	GATEWAY
TX	192640401	Medicaid
VA	1952363913	Medicaid
KY	3323281	Other	MEDICARE 855R
KY	3425381000	Other	PASSPORT ADVANTAGE
VA	P00403950	Other	MEDICARE RAILROAD
PA	1019370340001	Medicaid
WV	1071683	Other	WV WORKERS COMP
PA	1552459	Other	AETHNA
OH	2746970	Other	OH MEDICAL ASSISTANCE
KY	50017529	Other	PASSPORT-KCR
NY	02873783	Other	NY MEDICAL ASSISTANE
PA	1963836	Other	BLUE SHIELD
PA	219077	Other	UNISON
LA	5W398CK23	Other	MEDICARE 855R, 855I PTAN
VA	7232314	Medicaid
KY	91717	Other	SIHO-KCR
PA	101937034	Medicaid
LA	1664251	Medicaid
PA	1019370340001	Other	MEDICAL ASSISTANCE PA
KY	593623	Medicare PIN
LA	5W398CK23	Other	MEDICARE 855R, 855I PTAN
KY	91717	Other	SIHO-KCR
PA	1552459	Other	AETHNA
PA	1963836	Other	BLUE SHIELD
VA	3810010472	Medicaid
PA	113455	Medicare PIN
NY	02873783	Other	NY MEDICAL ASSISTANE
PA	219077	Other	UNISON
TX	8K4854	Medicare PIN
LA	1952363913	Medicare PIN
WV	1071683	Other	WV WORKERS COMP
KY	50017529	Other	PASSPORT-KCR
TX	192640401	Medicaid
PA	11698878	Medicare PIN