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NPI Code Detail

MEDICARE: MARIO ERNESTO MONTEALEGRE GALLEGOS MD

MEDICARE: MARIO ERNESTO MONTEALEGRE GALLEGOS MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207LC0200XCritical Care Medicine (Anesthesiology) Physician63039CT
2390200000XStudent in an Organized Health Care Education/Training Program268546MA
3207L00000XAnesthesiology Physician63039CT

General Provider Information

NPI Number : 1255781225
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIO ERNESTO MONTEALEGRE GALLEGOS MD
Provider Business Mailing Address
First Line : 333 CEDAR ST DEPT OF
Second Line :
City : NEW HAVEN
State : CT
Zip : 06510-3206
Country : US
Telephone Number : 617-459-5524
Fax Number :
Provider Business Practice Location Address
First Line : 330 BROOKLINE AVE # RABB239
Second Line :
City : BOSTON
State : MA
Zip : 02215-5400
Country : US
Telephone Number : 617-667-5048
Fax Number : 617-667-5050
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2016
Last Update Date : 06/06/2022

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