Individual
DR. COSTAS D. LALLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
833 CHESTNUT ST, SUITE 703, PHILADELPHIA, PA 19107-4414
(215) 955-1000
(215) 923-2275
Mailing address
833 CHESTNUT ST, SUITE 703, PHILADELPHIA, PA 19107-4414
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MD426721
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0074560
—
NJ
05
—
101344626
—
PA
Enumeration date
07/14/2006
Last updated
02/28/2014
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