Provider Demographics
NPI:1144273210
Name:ALLEY, ALBERT A (MD)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:A
Last Name:ALLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 CORNWALL ROAD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042
Mailing Address - Country:US
Mailing Address - Phone:717-273-0662
Mailing Address - Fax:717-270-9810
Practice Address - Street 1:1510 CORNWALL ROAD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042
Practice Address - Country:US
Practice Address - Phone:717-273-0662
Practice Address - Fax:717-270-9810
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD009878E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C29555Medicare UPIN
PA852785Medicare ID - Type Unspecified
PA0005958520002Medicaid