| Organization Name: | J RICHARD LILLY MD ABFP CHTD |
| NPI Number: | 1336135821 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | J RICHARD LILLY (OWNER) |
| Mailing Address: | 5804 Baltimore Ave Hyattsville |
| State: | MD US |
| Postal Code: | 207811623 |
| Phone Number: | 3019277800 |
| Fax Number: | 3019270375 |
| NPI Enumeration Date: | 09/21/2005 |
| NPI Last Update Date: | 02/09/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |