Provider Demographics
NPI:1336487503
Name:C A DILALLO MD
Entity Type:Organization
Organization Name:C A DILALLO MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:A
Authorized Official - Last Name:DILALLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-452-1256
Mailing Address - Street 1:9658 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1870
Mailing Address - Country:US
Mailing Address - Phone:301-452-1256
Mailing Address - Fax:443-274-2391
Practice Address - Street 1:7500 GREENWAY CENTER DR
Practice Address - Street 2:520
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3502
Practice Address - Country:US
Practice Address - Phone:301-220-2127
Practice Address - Fax:443-274-2391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-23
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD10535207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
295557Medicare PIN
MD617491200OtherWC
MD117871700Medicaid