Provider Demographics
NPI:1467719088
Name:PIKE, LILY (MD)
Entity type:Individual
Prefix:
First Name:LILY
Middle Name:
Last Name:PIKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1052 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-3225
Mailing Address - Country:US
Mailing Address - Phone:401-461-5056
Mailing Address - Fax:401-942-3590
Practice Address - Street 1:45 ROYAL LITTLE DR
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-1882
Practice Address - Country:US
Practice Address - Phone:401-808-6693
Practice Address - Fax:401-654-5319
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD15934207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1467719088Medicaid