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General NPI Number Information
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NPI Number | 1811217375
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Entity Type | Individual
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Provider Name | ANTHONY JAMES GALLO MD
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Gender | Male
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Dates
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Enumeration Date | 06/08/2010
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Last Update Date | 05/11/2015
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Provider Practice Location Address
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Address Line | 161 COLLEGE ST STE 1 RAD: DIAGNOSTIC
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City | PIKEVILLE
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State | KY
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Zip | 41501-4786
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Country | US
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Telephone | 606-432-1357
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Fax | 606-432-2457
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Provider Business Mailing Address
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Address Line | PO BOX 2648 RAD: DIAGNOSTIC
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City | PIKEVILLE
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State | KY
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Zip | 41502
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Country | US
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Telephone | 606-432-1357
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Fax | 606-432-2457
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 46405
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License Number State | KY
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