Provider Demographics
NPI:1992768709
Name:LAL, MADAN (MD PA)
Entity type:Individual
Prefix:DR
First Name:MADAN
Middle Name:
Last Name:LAL
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 239
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-0239
Mailing Address - Country:US
Mailing Address - Phone:919-934-3108
Mailing Address - Fax:919-938-1770
Practice Address - Street 1:925 N BRIGHTLEAF BLVD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4357
Practice Address - Country:US
Practice Address - Phone:919-934-3108
Practice Address - Fax:919-938-1770
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26839207W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7950626Medicaid
NC202830Medicare PIN
NCC81508Medicare UPIN
NC0807500001Medicare NSC