1144409434 NPI number — MARGARET S. LALLY, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144409434 NPI number — MARGARET S. LALLY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARGARET S. LALLY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144409434
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1382 OLD FREEPORT RD
Provider Second Line Business Mailing Address:
FIRST FLOOR REAR
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15238-3159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-967-1192
Provider Business Mailing Address Fax Number:
412-967-1195

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1382 OLD FREEPORT RD
Provider Second Line Business Practice Location Address:
FIRST 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:
11/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LALLY
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
SUE
Authorized Official Title or Position:
DERMATOLOGIST
Authorized Official Telephone Number:
412-967-1192

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  MD037362E , 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: 1445668 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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