Provider Demographics
NPI:1841381845
Name:LALOR, JOHN HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HENRY
Last Name:LALOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3452 RTE 31
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-9231
Mailing Address - Country:US
Mailing Address - Phone:315-652-1325
Mailing Address - Fax:
Practice Address - Street 1:3452 RTE 31
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-9231
Practice Address - Country:US
Practice Address - Phone:315-652-1325
Practice Address - Fax:315-652-5223
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY165587207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01200191Medicaid
A03065Medicare UPIN
NY01200191Medicaid