Provider Demographics
NPI:1144225368
Name:GALLOWAY, MARC T (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:T
Last Name:GALLOWAY
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 1:5246 SOCIALVILLE FOSTER RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-9302
Mailing Address - Country:US
Mailing Address - Phone:513-347-9999
Mailing Address - Fax:513-573-9178
Practice Address - Street 1:7423 S MASON MONTGOMERY RD
Practice Address - Street 2:SUITE A
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-7828
Practice Address - Country:US
Practice Address - Phone:513-347-9999
Practice Address - Fax:513-573-9178
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26627207XX0005X
OH58519207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64040116Medicaid
OH2185013Medicaid
KY0239462Medicare PIN
E38614Medicare UPIN
OH2185013Medicaid
OHGA4025443Medicare PIN