Provider Demographics
NPI:1417087321
Name:PATRICK T LALLY MD P C
Entity Type:Organization
Organization Name:PATRICK T LALLY MD P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:T
Authorized Official - Last Name:LALLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-537-6500
Mailing Address - Street 1:911 LIGONIER ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-1805
Mailing Address - Country:US
Mailing Address - Phone:724-537-6500
Mailing Address - Fax:724-537-7516
Practice Address - Street 1:911 LIGONIER ST
Practice Address - Street 2:SUITE 102
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1805
Practice Address - Country:US
Practice Address - Phone:724-537-6500
Practice Address - Fax:724-537-7516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024010E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA219637OtherHEALTH AMERICA
PA0009123600001Medicaid
PA1941827OtherPA BLUE SHIELD
PA219637OtherHEALTH ASSURANCE
PA1001159OtherGATEWAY HEALTH PLAN
PAV02278OtherUPMC
PA1295739OtherUNITED MINE WORKERS
PA60362OtherUNISON HEALTH PLAN
PA219637OtherADVANTRA
PA219637OtherADVANTRA
PAV02278OtherUPMC
PA1941827OtherPA BLUE SHIELD