Provider Demographics
NPI:1215920178
Name:CARDONA, LILLIAN MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:LILLIAN
Middle Name:MARIE
Last Name:CARDONA
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 1:19735 GERMANTOWN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1214
Mailing Address - Country:US
Mailing Address - Phone:301-917-6513
Mailing Address - Fax:301-917-6501
Practice Address - Street 1:19735 GERMANTOWN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1214
Practice Address - Country:US
Practice Address - Phone:301-917-6513
Practice Address - Fax:301-917-6501
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2011-08-09
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
MDD46930207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD229471100Medicaid
MDD46930OtherSTATE LICENSE
MD229471100Medicaid
MDF70010Medicare UPIN