Individual provider Active NPI

Michelle A Lally, MD

  • Infectious Disease Physician
  • Providence, RI
National Provider Identifier
1780638015
Registry record updated Nov 14, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
MD09871 Issued in RI
Practice address
164 Summit Ave
Fain BLDG., Suite E
Providence, RI 02906-2853
Phone
(401) 793-2928
Fax
(401) 793-7401
NPI assigned
May 20, 2006
Last updated
Nov 14, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease Physician 207RI0200X MD09871 RI Primary

Addresses

Primary practice location

164 Summit Ave
Fain BLDG., Suite E
Providence, RI 02906-2853

Mailing address

PO Box 1358
Providence, RI 02901-1358

Other identifiers 1

IdentifierTypeStateIssuer
7006558MedicaidRI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040611000952 RI Practitioner - Infectious DiseasePractitioner - Internal Medicine 2860475571

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": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194998400000",
    "number": "1780638015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1358",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029011358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 SUMMIT AVE",
            "address_2": "FAIN BLDG., SUITE E",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029062853",
            "telephone_number": "401-793-2928",
            "fax_number": "401-793-7401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LALLY",
        "first_name": "MICHELLE",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-20",
        "last_updated": "2007-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "RI",
            "license": "MD09871",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7006558",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.