=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366636888
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A GALLERANI MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2007
-----------------------------------------------------
Last Update Date | 04/23/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20950 NE 27TH CT SUITE 203
-----------------------------------------------------
City | AVENTURA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33180-1232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-933-6545
-----------------------------------------------------
Fax | 305-933-6661
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20950 NE 27TH CT SUITE 203
-----------------------------------------------------
City | AVENTURA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33180-1232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-933-6545
-----------------------------------------------------
Fax | 305-933-6661
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CEO
-----------------------------------------------------
Name | MARYANN BOGER-GALLERANI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 305-933-6545
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | ME91412
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------