Healthcare Provider Details

I. General information

NPI: 1689741894
Provider Name (Legal Business Name): MARK WILLIAM GALLAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11200 GOVERNOR MANLY WAY STE 309
RALEIGH NC
27614-7375
US

IV. Provider business mailing address

PO BOX 1107
WAKE FOREST NC
27588-1107
US

V. Phone/Fax

Practice location:
  • Phone: 919-562-9410
  • Fax: 919-562-2948
Mailing address:
  • Phone: 919-562-9410
  • Fax: 919-562-2948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number200301228
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number200301228
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: