Provider Demographics
NPI:1932170230
Name:PALLAN, LAURA A (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:A
Last Name:PALLAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 BACKBONE RD
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-1486
Mailing Address - Country:US
Mailing Address - Phone:412-264-2020
Mailing Address - Fax:412-375-7539
Practice Address - Street 1:960 BEAVER GRADE RD
Practice Address - Street 2:
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-2718
Practice Address - Country:US
Practice Address - Phone:412-264-2020
Practice Address - Fax:412-375-7539
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044348L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1541909Medicaid
700228NL8Medicare ID - Type Unspecified
PA1541909Medicaid