Healthcare Provider Details

I. General information

NPI: 1154357259
Provider Name (Legal Business Name): EMILIA VITOLO-GALLO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILIA VITOLO M.D.

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROUTE 422, SPORTSMAN ROAD BUILDING 37
WERNERSVILLE PA
19565-0300
US

IV. Provider business mailing address

907 OLD FRITZTOWN RD
SINKING SPRING PA
19608-9153
US

V. Phone/Fax

Practice location:
  • Phone: 610-678-3411
  • Fax:
Mailing address:
  • Phone: 610-670-7741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD036187E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: