Healthcare Provider Details

I. General information

NPI: 1174488845
Provider Name (Legal Business Name): MD ALLY SERVICES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3190 S VAUGHN WAY STE 550
AURORA CO
80014-3538
US

IV. Provider business mailing address

348 W 57TH ST STE 180
NEW YORK NY
10019-3702
US

V. Phone/Fax

Practice location:
  • Phone: 844-933-1911
  • Fax: 866-326-5428
Mailing address:
  • Phone: 844-933-1911
  • Fax: 866-326-5428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KAYLA K FAIRL
Title or Position: LCES
Credential:
Phone: 817-913-8837