Provider Demographics
NPI:1194727537
Name:LALLA, SUNIL V (MD)
Entity type:Individual
Prefix:DR
First Name:SUNIL
Middle Name:V
Last Name:LALLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1209
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-1209
Mailing Address - Country:US
Mailing Address - Phone:843-652-8220
Mailing Address - Fax:843-527-7080
Practice Address - Street 1:4367 RIVERWOOD DR
Practice Address - Street 2:SUITE 130
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-4368
Practice Address - Country:US
Practice Address - Phone:843-652-8390
Practice Address - Fax:843-652-8391
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC17757208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3021Medicaid
SCGP3021Medicaid
SCF93367Medicare UPIN