Healthcare Provider Details

I. General information

NPI: 1144225368
Provider Name (Legal Business Name): MARC T GALLOWAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7423 S MASON MONTGOMERY RD SUITE A
MASON OH
45040-7828
US

IV. Provider business mailing address

5246 SOCIALVILLE FOSTER RD SUITE A
MASON OH
45040-9302
US

V. Phone/Fax

Practice location:
  • Phone: 513-347-9999
  • Fax: 513-573-9178
Mailing address:
  • Phone: 513-347-9999
  • Fax: 513-573-9178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number26627
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number58519
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: