Individual
KATE MARIE LALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
450 BROOKLINE AVE, BOSTON, MA 02215-5418
(617) 632-6464
(617) 632-6180
Mailing address
450 BROOKLINE AVE, BOSTON, MA 02215-5418
(617) 632-6464
(617) 632-6180
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD425183
PA
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
275932
MA
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
MD13953
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2406111000
INDEPENDENCE BLUE CROSS
—
01
—
LA1739656
HIGHMARK BS
PA
Enumeration date
08/31/2006
Last updated
08/01/2018
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