Basic Information
| Provider Information | |||||||||
| NPI: | 1144393844 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TILLY | ||||||||
| FirstName: | ELENA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16800 QUEEN ANNE BRIDGE RD | ||||||||
| Address2: | PHYSICIAN BILLING | ||||||||
| City: | BOWIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207163433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017753272 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 BYRN ST | ||||||||
| Address2: | DORCHESTER GENERAL HOSPITAL | ||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216131908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102285511 | ||||||||
| FaxNumber: | 4102218783 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2006 | ||||||||
| LastUpdateDate: | 03/23/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 0101044796 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
No ID Information.