Individual
MR. GLEN NEAL LILLY II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
24035 THREE NOTCH RD, HOLLYWOOD, MD 20636-4871
(301) 373-7100
(301) 373-6100
Mailing address
PO BOX 640, HOLLYWOOD, MD 20636-0640
(301) 373-7100
(301) 373-6100
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C0009583
MD
363A00000X
Physician Assistant
TL2189
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
216982700
—
MD
01
—
2189
MEDICAL LICENSE
SC
Enumeration date
09/24/2014
Last updated
03/19/2026
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us