Provider Demographics
NPI:1811384290
Name:PATRICK T LALLY, M.D. PC
Entity Type:Organization
Organization Name:PATRICK T LALLY, M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:LALLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD PC
Authorized Official - Phone:724-537-6500
Mailing Address - Street 1:2000 TOWER WAY
Mailing Address - Street 2:SUITE 2039
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-5786
Mailing Address - Country:US
Mailing Address - Phone:724-832-5811
Mailing Address - Fax:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-23
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024010E332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009123600001Medicaid
PA0009123600001Medicaid