Individual
DR. LILLY KC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7900 SUDLEY RD STE 900, MANASSAS, VA 20109-2867
(571) 472-8200
(571) 472-6721
Mailing address
PO BOX 37189, BALTIMORE, MD 21297-3189
(571) 423-5699
(571) 423-5698
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101052436
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05622867
—
VA
01
—
080175698
RR MEDICARE
—
Enumeration date
09/01/2005
Last updated
04/23/2026
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