Individual
FREDERICK P LILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
224D CORNWALL ST NW, SUITE 302, LEESBURG, VA 20176-2700
(703) 737-7622
(703) 737-7943
Mailing address
224D CORNWALL ST NW, SUITE 302, LEESBURG, VA 20176-2700
(703) 737-7622
(703) 737-7943
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101022634
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
061845
ANTHEM BLUE CROSS
VA
Enumeration date
06/24/2006
Last updated
11/01/2012
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