Healthcare Provider Details

I. General information

NPI: 1639601297
Provider Name (Legal Business Name): THOMAS JOHN GALLETTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE, ML 7015
CINCINNATI OH
45229
US

IV. Provider business mailing address

3333 BURNET AVE, ML 7015
CINCINNATI OH
45229
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4266
  • Fax: 513-636-3549
Mailing address:
  • Phone: 513-636-4266
  • Fax: 513-636-3549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number35.139017
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: