Basic Information
| Provider Information | |||||||||
| NPI: | 1083737399 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORREOSO THOMAS | ||||||||
| FirstName: | LYLA | ||||||||
| MiddleName: | JANEIL | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6400 SHAFER CT STE 700 | ||||||||
| Address2: | |||||||||
| City: | ROSEMONT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600184989 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3463761702 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5457 TWIN KNOLLS RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210453263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106897400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2007 | ||||||||
| LastUpdateDate: | 10/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0002X | 150944 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine |
No ID Information.