MEDICARE: PETER L GALLARELLO DPM

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	213E00000X	Podiatrist	9901	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366459471
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETER L GALLARELLO DPM

Provider Business Mailing Address
First Line	:	1703 CIVIC CENTER DR STE 3
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7273
Country	:	US
Telephone Number	:	702-791-3668
Fax Number	:

Provider Business Practice Location Address
First Line	:	1703 CIVIC CENTER DR STE 3
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7273
Country	:	US
Telephone Number	:	702-791-3668
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PETER L GALLARELLO
Credential	:	D.P.M.
Telephone Number	:	702-791-3668

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	02/27/2010

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