Provider Demographics
NPI:1982750238
Name:LALLY, MICHAEL EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EDWARD
Last Name:LALLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1050 BOWER HILL RD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-1800
Mailing Address - Country:US
Mailing Address - Phone:412-207-2632
Mailing Address - Fax:412-892-9798
Practice Address - Street 1:1050 BOWER HILL RD
Practice Address - Street 2:SUITE 309
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15243-1800
Practice Address - Country:US
Practice Address - Phone:412-207-2632
Practice Address - Fax:412-892-9798
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD 021801E2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0948077Medicaid
PA056550Medicare ID - Type UnspecifiedSURGEON
PAB34527Medicare UPIN