Provider Demographics
NPI:1144208810
Name:GALLON, RAYMOND M (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:M
Last Name:GALLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9335 MCKNIGHT RD FL 1
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-5903
Mailing Address - Country:US
Mailing Address - Phone:412-847-2020
Mailing Address - Fax:412-847-2025
Practice Address - Street 1:9335 MCKNIGHT RD FL 1
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-5903
Practice Address - Country:US
Practice Address - Phone:412-847-2020
Practice Address - Fax:412-847-2025
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD419856207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019087000006Medicaid
PACG1496Medicare PIN
PA110241606Medicare PIN
PAH69123Medicare UPIN
PA061184NJKMedicare PIN