Healthcare Provider Details

I. General information

NPI: 1265433635
Provider Name (Legal Business Name): GLORIA M GALLOWAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MCMILLEN DR
NEWARK OH
43055-1811
US

IV. Provider business mailing address

150 MCMILLEN DR
NEWARK OH
43055-1811
US

V. Phone/Fax

Practice location:
  • Phone: 220-564-7985
  • Fax: 220-564-7986
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35.074941
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number35074941
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: