1811217375 NPI number — ANTHONY JAMES GALLO MD

Table of content: ANTHONY JAMES GALLO MD (NPI 1811217375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811217375 NPI number — ANTHONY JAMES GALLO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GALLO
Provider First Name:
ANTHONY
Provider Middle Name:
JAMES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811217375
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2648
Provider Second Line Business Mailing Address:
RAD: DIAGNOSTIC
Provider Business Mailing Address City Name:
PIKEVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-432-1357
Provider Business Mailing Address Fax Number:
606-432-2457

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
161 COLLEGE ST STE 1
Provider Second Line Business Practice Location Address:
RAD: DIAGNOSTIC
Provider Business Practice Location Address City Name:
PIKEVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41501-4786
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-432-1357
Provider Business Practice Location Address Fax Number:
606-432-2457
Provider Enumeration Date:
06/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  46405 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2014248664 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100297390 . This is a "KENTUCKY MEDICAID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 986408 . This is a "WELLCARE OF KENTUCKY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 304018 . This is a "COVENTRY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 3810028087 . This is a "MOLINA WEST VA MAA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 000000872442 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P01342718 . This is a "PALMETTO GBA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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