Provider Demographics
NPI:1447219878
Name:SCALLY, LOUBNA T (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUBNA
Middle Name:T
Last Name:SCALLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8310
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-0310
Mailing Address - Country:US
Mailing Address - Phone:540-345-3556
Mailing Address - Fax:540-342-2193
Practice Address - Street 1:1111 S JEFFERSON ST STE B
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4724
Practice Address - Country:US
Practice Address - Phone:540-769-3964
Practice Address - Fax:540-342-2193
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101276310207RG0300X
NMMD2012-00122085R0001X, 208D00000X
WV217762085R0001X
IN01063079A2085R0001X
FLME156131207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN9365920OtherPHCS PID NUMBER
WV3810001728Medicaid
NMNPI & TINOtherBCBS OF NM
NM95220771Medicaid
IN000000506581OtherANTHEM PROVIDER NUMBER
IN200851560Medicaid
NMNMAAA2647Medicare PIN
NM95220771Medicaid
IN815450GGMedicare PIN
IN000000506581OtherANTHEM PROVIDER NUMBER
INI23519Medicare UPIN
INP00381704Medicare PIN