Provider Demographics
NPI:1275528549
Name:GALLUCCI, ROBERT E (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:GALLUCCI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 BALD HILL RD
Mailing Address - Street 2:STE 503
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1617
Mailing Address - Country:US
Mailing Address - Phone:401-738-7750
Mailing Address - Fax:401-738-9750
Practice Address - Street 1:400 BALD HILL RD
Practice Address - Street 2:STE 503
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1617
Practice Address - Country:US
Practice Address - Phone:401-738-7750
Practice Address - Fax:401-738-9750
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDPM 00255213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI21286-7OtherBLUE CROSS
RI7008421Medicaid
RI203859OtherBLUE CHIP
RI007008421Medicare ID - Type Unspecified
RI21286-7OtherBLUE CROSS
U02691Medicare UPIN