1104858166 NPI number — DR. MARGARET SUE LALLY MD

Table of content: DR. MARGARET SUE LALLY MD (NPI 1104858166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104858166 NPI number — DR. MARGARET SUE LALLY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LALLY
Provider First Name:
MARGARET
Provider Middle Name:
SUE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LALLY
Provider Other First Name:
MARGARET
Provider Other Middle Name:
SUE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1104858166
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 BUCKINGHAM ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-967-9448
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1382 OLD FREEPORT ROAD
Provider Second Line Business Practice Location Address:
1ST FLOOR - REAR
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15238-3159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-967-1192
Provider Business Practice Location Address Fax Number:
412-967-1195
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  037362E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7289191004 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1004748 . This is a "GATEWAY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4104433 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 78438 . This is a "MED PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1445668 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 102344 . This is a "UPMC" identifier . This identifiers is of the category "OTHER".




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