1326428046 NPI number — DR. TODD LILJE M.D.

Table of content: DR. TODD LILJE M.D. (NPI 1326428046)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326428046 NPI number — DR. TODD LILJE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LILJE
Provider First Name:
TODD
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326428046
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
WALTER REED NATIONAL MILITARY CTR
Provider Second Line Business Mailing Address:
8901 WISCONSIN AVE.
Provider Business Mailing Address City Name:
BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20889-5600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-400-1622
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
U.S. NAVAL HOSPITAL GUAM
Provider Second Line Business Practice Location Address:
BUILDING #50 FARENHOLT AVE.
Provider Business Practice Location Address City Name:
AGANA HEIGHTS
Provider Business Practice Location Address State Name:
GU
Provider Business Practice Location Address Postal Code:
96910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
671-344-9378
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/08/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  0101260904 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)