Provider Demographics
NPI:1750379202
Name:LALE, EROL (MD)
Entity type:Individual
Prefix:
First Name:EROL
Middle Name:
Last Name:LALE
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 1:207 CHARTWELL CT
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-9999
Mailing Address - Country:US
Mailing Address - Phone:843-293-2700
Mailing Address - Fax:843-293-4960
Practice Address - Street 1:207 CHARTWELL CT
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-9999
Practice Address - Country:US
Practice Address - Phone:843-293-2700
Practice Address - Fax:843-293-4960
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26572207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC265723Medicaid
SCH22057Medicare UPIN
SC7829Medicare PIN