Provider Demographics
NPI:1104847193
Name:ALBERT A. ALLEY, LTD
Entity Type:Organization
Organization Name:ALBERT A. ALLEY, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-273-0662
Mailing Address - Street 1:1510 CORNWALL RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-7479
Mailing Address - Country:US
Mailing Address - Phone:717-273-0662
Mailing Address - Fax:717-270-9810
Practice Address - Street 1:1510 CORNWALL RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7479
Practice Address - Country:US
Practice Address - Phone:717-273-0662
Practice Address - Fax:717-270-9810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD009878E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005958520002Medicaid
PA0005958520002Medicaid
PA852785Medicare ID - Type Unspecified