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General NPI Number Information
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NPI Number | 1417087321
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Entity Type | Organization
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Legal Business Name | PATRICK T LALLY MD P C
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 03/25/2008
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Provider Practice Location Address
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Address Line | 911 LIGONIER ST SUITE 102
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City | LATROBE
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State | PA
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Zip | 15650-1805
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Country | US
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Telephone | 724-537-6500
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Fax | 724-537-7516
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Provider Business Mailing Address
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Address Line | 911 LIGONIER ST SUITE 102
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City | LATROBE
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State | PA
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Zip | 15650-1805
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Country | US
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Telephone | 724-537-6500
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Fax | 724-537-7516
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Authorized Official
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Title or Position | OPHTHALMOLOGIST
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Name | DR. PATRICK T LALLY
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Credential | MD
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Telephone | 724-537-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD024010E
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License Number State | PA
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