Provider Demographics
NPI:1528046521
Name:LILLIS, LINDA R (CNM)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:R
Last Name:LILLIS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 ABBOTT RD
Mailing Address - Street 2:MERCY HOSPITAL DEPT OB/GYN
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14220-2039
Mailing Address - Country:US
Mailing Address - Phone:716-828-2600
Mailing Address - Fax:716-828-2701
Practice Address - Street 1:565 ABBOTT RD
Practice Address - Street 2:MERCY HOSPITAL DEPT OB/GYN
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14220-2039
Practice Address - Country:US
Practice Address - Phone:716-828-2600
Practice Address - Fax:716-828-2701
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW 010037176B00000X
NY28-001303176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA591565Medicare ID - Type Unspecified