Individual
DR. LAWRENCE EDWARD TILLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
23000 MOAKLEY ST, #203, LEONARDTOWN, MD 20650-2915
(301) 475-8599
(301) 475-1514
Mailing address
23000 MOAKLEY ST, #203, LEONARDTOWN, MD 20650-2915
(301) 475-8599
(301) 475-1514
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
D28647
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1405390004
CIGNA
—
01
—
2589469
AETNA
—
01
—
479847
MAMSI
—
01
—
LY13LA
BLUE SHIELD, MD
—
01
—
R031
BLUE SHIELD, DC
—
Enumeration date
05/22/2006
Last updated
12/28/2007
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