Provider Demographics
NPI:1407882806
Name:LALL, SHOBHA U (MD)
Entity Type:Individual
Prefix:DR
First Name:SHOBHA
Middle Name:U
Last Name:LALL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1432 CLARK ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-8745
Mailing Address - Country:US
Mailing Address - Phone:740-439-6664
Mailing Address - Fax:740-439-8664
Practice Address - Street 1:1432 CLARK ST
Practice Address - Street 2:SUITE 5
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-8745
Practice Address - Country:US
Practice Address - Phone:740-439-6664
Practice Address - Fax:740-439-8664
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35039646208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH44440OtherCORE SOURCE
OH0310685Medicaid
OH1200270OtherUNITED HEALTH PLAN
OHC0039646OtherHEALTH PLAN OF UPPER OHIO