Healthcare Provider Details

I. General information

NPI: 1275452948
Provider Name (Legal Business Name): LUCAS GALLO MD, MSC, PHD, FRCSC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3380 BOULEVARD OF THE ALLIES STE 158
PITTSBURGH PA
15213-3125
US

IV. Provider business mailing address

3380 BOULEVARD OF THE ALLIES STE 158
PITTSBURGH PA
15213-3125
US

V. Phone/Fax

Practice location:
  • Phone: 412-641-3960
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberMD495828
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberMD495828
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberMD495828
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD495828
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: