Provider Demographics
NPI:1013559871
Name:LALLO, AMBER BROOKE (PA)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:BROOKE
Last Name:LALLO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 OLD LANCASTER RD STE 320
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3235
Mailing Address - Country:US
Mailing Address - Phone:610-527-3800
Mailing Address - Fax:
Practice Address - Street 1:825 OLD LANCASTER RD STE 350
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3238
Practice Address - Country:US
Practice Address - Phone:610-527-8118
Practice Address - Fax:610-527-3296
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA061099363A00000X
FLPA9113918363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant