Healthcare Provider Details

I. General information

NPI: 1235356379
Provider Name (Legal Business Name): ROBERT AUGUST GALLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HOPE DR BLDG A BONE AND JOINT INSTITUTE, EC089
HERSHEY PA
17033-2036
US

IV. Provider business mailing address

30 HOPE DR BLDG A BONE AND JOINT INSTITUTE, EC089
HERSHEY PA
17033-2036
US

V. Phone/Fax

Practice location:
  • Phone: 717-531-5638
  • Fax: 717-531-7583
Mailing address:
  • Phone: 717-531-5638
  • Fax: 717-531-7583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberMD428807
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number244654
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: