Provider Demographics
NPI:1235315276
Name:LAUREEN GALLO INC
Entity Type:Organization
Organization Name:LAUREEN GALLO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLO
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:410-213-7937
Mailing Address - Street 1:12417 OCEAN GTWY
Mailing Address - Street 2:A6
Mailing Address - City:OCEAN CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21842-9521
Mailing Address - Country:US
Mailing Address - Phone:410-213-7937
Mailing Address - Fax:410-213-7939
Practice Address - Street 1:12417 OCEAN GTWY
Practice Address - Street 2:A6
Practice Address - City:OCEAN CITY
Practice Address - State:MD
Practice Address - Zip Code:21842-9521
Practice Address - Country:US
Practice Address - Phone:410-213-7937
Practice Address - Fax:410-213-7939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-20
Last Update Date:2008-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001194155363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD146021800Medicaid
R95748Medicare UPIN
439M632IMedicare Oscar/Certification