Healthcare Provider Details

I. General information

NPI: 1558367391
Provider Name (Legal Business Name): GARY L. GALLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 E MAIN ST STE 1
WAYNESBORO PA
17268-2318
US

IV. Provider business mailing address

1051 E MAIN ST STE 1
WAYNESBORO PA
17268-2318
US

V. Phone/Fax

Practice location:
  • Phone: 717-762-9118
  • Fax: 717-762-2860
Mailing address:
  • Phone: 717-762-9118
  • Fax: 717-762-2860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD066174L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: