Provider Demographics
NPI:1144409434
Name:MARGARET S. LALLY, LLC
Entity Type:Organization
Organization Name:MARGARET S. LALLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:LALLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-967-1192
Mailing Address - Street 1:1382 OLD FREEPORT RD
Mailing Address - Street 2:FIRST FLOOR REAR
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-3159
Mailing Address - Country:US
Mailing Address - Phone:412-967-1192
Mailing Address - Fax:412-967-1195
Practice Address - Street 1:1382 OLD FREEPORT RD
Practice Address - Street 2:FIRST 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037362E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1445668OtherBLUE SHIELD
PA1445668OtherBLUE SHIELD