Individual
MATTHEW LALLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
201 WAVERLEY DR, FREDERICK, MD 21702-3802
(240) 236-3900
Mailing address
201 WAVERLEY DR, FREDERICK, MD 21702-3802
(240) 236-3900
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
12073731
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
541628100
—
MD
Enumeration date
12/05/2018
Last updated
12/05/2018
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