Provider Demographics
NPI:1104858166
Name:LALLY, MARGARET SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:SUE
Last Name:LALLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARGARET
Other - Middle Name:SUE
Other - Last Name:LALLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:401 BUCKINGHAM ROAD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15215
Mailing Address - Country:US
Mailing Address - Phone:412-967-9448
Mailing Address - Fax:
Practice Address - Street 1:1382 OLD FREEPORT ROAD
Practice Address - Street 2:1ST FLOOR - REAR
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-3159
Practice Address - Country:US
Practice Address - Phone:412-967-1192
Practice Address - Fax:412-967-1195
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA037362E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
7289191004OtherCIGNA
1004748OtherGATEWAY
4104433OtherAETNA
78438OtherMED PLUS
1445668OtherBLUE CROSS BLUE SHIELD
102344OtherUPMC
LA414566Medicare ID - Type Unspecified
E36493Medicare UPIN