Provider Demographics
NPI:1548247695
Name:LILLE, ROBERT D (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
Last Name:LILLE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:541 MAIN ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1845
Mailing Address - Country:US
Mailing Address - Phone:781-340-1702
Mailing Address - Fax:781-340-0931
Practice Address - Street 1:541 MAIN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1845
Practice Address - Country:US
Practice Address - Phone:781-340-1702
Practice Address - Fax:781-340-0931
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2014-05-06
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Provider Licenses
StateLicense IDTaxonomies
MA31780207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2029561Medicaid
MA66615OtherHARVARD PILGRIM
MAB48117OtherBLUE CROSS BLUE SHIELD
MA710127OtherTUFTS HEALTH PLAN
MA2029561Medicaid
MAB73244Medicare UPIN