MEDICARE: JOSEPH M LALLY JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	16001	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891770962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH M LALLY JR. M.D.

Provider Business Mailing Address
First Line	:	PO BOX 91734
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23291-1734
Country	:	US
Telephone Number	:	804-358-6100
Fax Number	:	804-342-7619

Provider Business Practice Location Address
First Line	:	125 DOUGHTY ST
Second Line	:	STE 330
City	:	CHARLESTON
State	:	SC
Zip	:	29403-5736
Country	:	US
Telephone Number	:	843-722-7705
Fax Number	:	843-722-7149

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	11/25/2020

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