Provider Demographics
NPI:1609192004
Name:NALLY, LAURA M (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:NALLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:M
Other - Last Name:NALLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1 PARK ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06504-8901
Mailing Address - Country:US
Mailing Address - Phone:203-785-4081
Mailing Address - Fax:203-737-7635
Practice Address - Street 1:1 PARK ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06504-8901
Practice Address - Country:US
Practice Address - Phone:203-785-4081
Practice Address - Fax:203-737-7635
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1256022080P0205X
CT61675208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology