Provider Demographics
NPI:1679568679
Name:MAHROKHIAN, LILIAN S (MD)
Entity type:Individual
Prefix:DR
First Name:LILIAN
Middle Name:S
Last Name:MAHROKHIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-6002
Mailing Address - Country:US
Mailing Address - Phone:857-307-0896
Mailing Address - Fax:
Practice Address - Street 1:850 BOYLSTON ST
Practice Address - Street 2:SUITE 402
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2477
Practice Address - Country:US
Practice Address - Phone:617-732-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151557207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMAJ17036OtherBXBS
0004077OtherNEIGHBORHOOD HEALTH PLAN
MA151557OtherTUFTS
MA3158900Medicaid
585494OtherAETNA US HEALTHCARE
66120OtherHARVARD PILGRIM HEALTHCAR
0401326OtherUNITED HEALTHCARE
043235613OtherTAX ID GROUP BILLING NUMB
MA3158900Medicaid
66120OtherHARVARD PILGRIM HEALTHCAR
110195962Medicare ID - Type UnspecifiedPALMETTO GBA RAILROAD