Active NPI
Edward V Lally, MD
- Rheumatology Physician
- E. Providence, RI
National Provider Identifier
1770520090
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rheumatology Physician
- License
- MD05751
- Practice address
- 375 Wampanoag Trail
Suite 202B
E. Providence, RI 02915 - Phone
- (401) 649-4040
- Fax
- (401) 649-4041
- NPI assigned
- Jun 2, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rheumatology Physician | 207RR0500X | MD05751 | RI | Primary |
Addresses
Primary practice location
375 Wampanoag Trail
Suite 202B
E. Providence, RI 02915
Mailing address
375 Wampanoag Trail
Suite 202B
E. Providence, RI 02915
Phone (401) 649-4040
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9006047 | Medicaid | RI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476230400000",
"number": "1770520090",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "375 WAMPANOAG TRAIL",
"address_2": "SUITE 202B",
"city": "E. PROVIDENCE",
"state": "RI",
"postal_code": "02915",
"telephone_number": "401-649-4040",
"fax_number": "401-649-4041"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "375 WAMPANOAG TRAIL",
"address_2": "SUITE 202B",
"city": "E. PROVIDENCE",
"state": "RI",
"postal_code": "02915",
"telephone_number": "401-649-4040",
"fax_number": "401-649-4041"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LALLY",
"first_name": "EDWARD",
"middle_name": "V",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-02",
"last_updated": "2016-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "207RR0500X",
"taxonomy_group": "",
"desc": "Internal Medicine, Rheumatology",
"state": "RI",
"license": "MD05751",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9006047",
"state": "RI"
}
],
"endpoints": [],
"other_names": []
}Other providers in E. Providence, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.