Basic Information
| Provider Information | |||||||||
| NPI: | 1679568679 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAHROKHIAN | ||||||||
| FirstName: | LILIAN | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 CYPRESS ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLINE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024456002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8573070896 | ||||||||
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| Practice Location | |||||||||
| Address1: | 850 BOYLSTON ST | ||||||||
| Address2: | SUITE 402 | ||||||||
| City: | CHESTNUT HILL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024672477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177329300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2005 | ||||||||
| LastUpdateDate: | 07/23/2012 | ||||||||
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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 | 207R00000X | 151557 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | MAJ17036 | 01 | MA | BXBS | OTHER | 0004077 | 01 | NEIGHBORHOOD HEALTH PLAN | OTHER | 151557 | 01 | MA | TUFTS | OTHER | 3158900 | 05 | MA | MEDICAID | 585494 | 01 | AETNA US HEALTHCARE | OTHER | 66120 | 01 | HARVARD PILGRIM HEALTHCAR | OTHER | 0401326 | 01 | UNITED HEALTHCARE | OTHER | 043235613 | 01 | TAX ID GROUP BILLING NUMB | OTHER |