Provider Demographics
NPI:1871573683
Name:LILLO, NICHOLAS L (MD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:L
Last Name:LILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:19 PEMBROKE HILL
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1461
Mailing Address - Country:US
Mailing Address - Phone:860-224-2447
Mailing Address - Fax:860-826-5845
Practice Address - Street 1:40 HART ST
Practice Address - Street 2:BLDG A
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1743
Practice Address - Country:US
Practice Address - Phone:860-224-2447
Practice Address - Fax:860-826-5845
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT023048207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC64873Medicare UPIN