Healthcare Provider Details

I. General information

NPI: 1750614467
Provider Name (Legal Business Name): MATTHEW CHARLES LALLY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2009
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 KNOB HILL ST
SHARON MA
02067-3118
US

IV. Provider business mailing address

42 KNOB HILL ST
SHARON MA
02067-3118
US

V. Phone/Fax

Practice location:
  • Phone: 508-850-6277
  • Fax: 508-850-6277
Mailing address:
  • Phone: 508-850-6277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number245336
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: