Healthcare Provider Details

I. General information

NPI: 1780622449
Provider Name (Legal Business Name): ANTHONY LOUIS GALLO JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 SCRABBLETOWN RD STE A
NORTH KINGSTOWN RI
02852-3638
US

IV. Provider business mailing address

420 SCRABBLETOWN RD STE A
NORTH KINGSTOWN RI
02852-3638
US

V. Phone/Fax

Practice location:
  • Phone: 401-268-5333
  • Fax: 401-268-5330
Mailing address:
  • Phone: 401-268-5333
  • Fax: 401-268-5330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number200535
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD11767
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberMD11767
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: