Provider Demographics
NPI:1891770962
Name:LALLY, JOSEPH M JR (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:LALLY
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 91734
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23291-1734
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:804-342-7619
Practice Address - Street 1:125 DOUGHTY ST
Practice Address - Street 2:STE 330
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5736
Practice Address - Country:US
Practice Address - Phone:843-722-7705
Practice Address - Fax:843-722-7149
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2020-11-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC16001207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC160015Medicaid
SC160015Medicaid