Provider Demographics
NPI:1457686586
Name:LALLY, DAVID RYAN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:RYAN
Last Name:LALLY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3640 MAIN ST
Mailing Address - Street 2:STE 201
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1145
Mailing Address - Country:US
Mailing Address - Phone:413-732-2333
Mailing Address - Fax:413-732-8065
Practice Address - Street 1:3640 MAIN ST
Practice Address - Street 2:STE 201
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1145
Practice Address - Country:US
Practice Address - Phone:413-732-2333
Practice Address - Fax:413-732-8065
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2016-03-09
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Provider Licenses
StateLicense IDTaxonomies
OH57.016146207R00000X
PAMT196557207W00000X
DEC1-0010130207W00000X
MA254315207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine