| Daniel Chan Ly, DO | |
| 
					1431 Nursery St Ste 102, Fogelsville, PA 18051-1612  | |
| (610) 821-4920 | |
| (610) 821-1358 | 
| Full Name | Daniel Chan Ly | 
|---|---|
| Gender | Male | 
| Speciality | Pediatrics | 
| Location | 1431 Nursery St Ste 102, Fogelsville, Pennsylvania | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1194217224 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 208000000X | Pediatrics | OT018602 (Pennsylvania) | Secondary | 
| 208000000X | Pediatrics | OS021279 (Pennsylvania) | Primary | 
| Entity Name | Lehigh Valley Physician Group | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1457309650 PECOS PAC ID: 3072425123 Enrollment ID: O20040227000335  | 
| Mailing Address | Practice Location Address | 
|---|---|
| Daniel Chan Ly, DO 2100 Mack Blvd, Allentown, PA 18103-5622 Ph: (484) 884-0617  | Daniel Chan Ly, DO 1431 Nursery St Ste 102, Fogelsville, PA 18051-1612 Ph: (610) 821-4920  | 
Natalie K Caruso, DO Pediatrics Medicare: Medicare Enrolled Practice Location: 1431 Nursery St Ste 102, Fogelsville, PA 18051 Phone: 610-336-8277  | |
Dr. Michael Lenneville, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 1431 Nursery St Ste 102, Fogelsville, PA 18051 Phone: 610-821-4920  | |
Katelyn Suzanne Lindner, D.O. Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 1431 Nursery St, Fogelsville, PA 18051 Phone: 610-821-4920 Fax: 610-821-1358  |