Provider Demographics
NPI:1306183389
Name:MARIANO A GALANG III M.D., PSC
Entity Type:Organization
Organization Name:MARIANO A GALANG III M.D., PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIANO
Authorized Official - Middle Name:A
Authorized Official - Last Name:GALANG
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:502-897-1511
Mailing Address - Street 1:1406 BROWNS LN STE G
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4656
Mailing Address - Country:US
Mailing Address - Phone:502-897-1511
Mailing Address - Fax:
Practice Address - Street 1:1406 BROWNS LN STE G
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4656
Practice Address - Country:US
Practice Address - Phone:502-897-1511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYBC2706452OtherDEA
KYE74724Medicare UPIN