Individual
LILY ANN BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4199 WASHINGTON ST, ROSLINDALE, MA 02131-1733
(405) 821-1155
Mailing address
4199 WASHINGTON ST, ROSLINDALE, MA 02131-1733
(405) 821-1155
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1016219
MA
Other
Enumeration date
04/10/2020
Last updated
04/02/2024
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