Provider Demographics
NPI:1982617544
Name:GONZALEZ, LILAH C (MD)
Entity Type:Individual
Prefix:DR
First Name:LILAH
Middle Name:C
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:314 FRANKLIN AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1215
Mailing Address - Country:US
Mailing Address - Phone:410-641-2696
Mailing Address - Fax:410-641-3834
Practice Address - Street 1:314 FRANKLIN AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1215
Practice Address - Country:US
Practice Address - Phone:410-641-2696
Practice Address - Fax:410-641-3834
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD26798207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD76235Medicare UPIN
MD825M439FMedicare ID - Type Unspecified