Provider Demographics
NPI:1104811645
Name:KRAMAN-ROACH, LILLIAN VIRGINIA (MD)
Entity type:Individual
Prefix:DR
First Name:LILLIAN
Middle Name:VIRGINIA
Last Name:KRAMAN-ROACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 589
Mailing Address - Street 2:
Mailing Address - City:CAMDEN WYOMING
Mailing Address - State:DE
Mailing Address - Zip Code:19934-0589
Mailing Address - Country:US
Mailing Address - Phone:302-674-9188
Mailing Address - Fax:302-674-1108
Practice Address - Street 1:846 WALKER RD
Practice Address - Street 2:SUITE 31-2
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-2756
Practice Address - Country:US
Practice Address - Phone:302-674-9188
Practice Address - Fax:302-674-1108
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC100046882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
824062Medicare ID - Type Unspecified
C75749Medicare UPIN