Healthcare Provider Details

I. General information

NPI: 1518722362
Provider Name (Legal Business Name): JANET GALLA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8118 GOOD LUCK RD
LANHAM MD
20706-3574
US

IV. Provider business mailing address

1620 EBBOTTS PL
CROFTON MD
21114-1503
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-1657
  • Fax:
Mailing address:
  • Phone: 443-254-3562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR236983
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR236983
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: