Provider Demographics
NPI:1104920065
Name:LILLARD, PIPER P (DO)
Entity type:Individual
Prefix:
First Name:PIPER
Middle Name:P
Last Name:LILLARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 EASTBROOK HTS APT B
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06250-1669
Mailing Address - Country:US
Mailing Address - Phone:860-456-0586
Mailing Address - Fax:
Practice Address - Street 1:921 BOSTON TPKE
Practice Address - Street 2:SUITE 2
Practice Address - City:BOLTON
Practice Address - State:CT
Practice Address - Zip Code:06043-7403
Practice Address - Country:US
Practice Address - Phone:860-646-0649
Practice Address - Fax:860-649-9195
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT230057207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine