Healthcare Provider Details

I. General information

NPI: 1932381035
Provider Name (Legal Business Name): KETAN GALA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2339 ROUTE 70 W
CHERRY HILL NJ
08002-3315
US

IV. Provider business mailing address

1 COOPER PLAZA 3 DORRANCE, D390
CAMDEN NJ
08103-1461
US

V. Phone/Fax

Practice location:
  • Phone: 856-325-6700
  • Fax:
Mailing address:
  • Phone: 856-342-2000
  • Fax: 609-710-7494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License NumberMD439768
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD439768
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA09146000
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number25MA09146000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: