Healthcare Provider Details

I. General information

NPI: 1861562746
Provider Name (Legal Business Name): DANIEL LAWRENCE GALLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 HOSPITAL WAY STE 100
SOMERSET KY
42503-1872
US

IV. Provider business mailing address

350 HOSPITAL WAY STE 100
SOMERSET KY
42503-1872
US

V. Phone/Fax

Practice location:
  • Phone: 606-451-2600
  • Fax: 606-451-2651
Mailing address:
  • Phone: 850-883-9906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number40657
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number40657
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: