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
1	207LC0200X	Critical Care Medicine (Anesthesiology) Physician	63039	CT
2	390200000X	Student in an Organized Health Care Education/Training Program	268546	MA
3	207L00000X	Anesthesiology Physician	63039	CT

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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