Healthcare Provider Details

I. General information

NPI: 1083842579
Provider Name (Legal Business Name): GRETCHEN GALLIANO GOOCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRETCHEN EILEEN GALLIANO MD

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 JEFFERSON HWY
NEW ORLEANS LA
70121-2429
US

IV. Provider business mailing address

1514 JEFFERSON HWY
NEW ORLEANS LA
70121-2429
US

V. Phone/Fax

Practice location:
  • Phone: 504-842-3330
  • Fax:
Mailing address:
  • Phone: 504-842-3330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberA93579
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberMD.200058
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: