Provider Demographics
NPI:1376579300
Name:GALASSO, JAMES WILLIAM III (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WILLIAM
Last Name:GALASSO
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SWOYERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18704-1318
Mailing Address - Country:US
Mailing Address - Phone:570-283-3301
Mailing Address - Fax:570-283-3304
Practice Address - Street 1:1200 MAIN ST
Practice Address - Street 2:
Practice Address - City:SWOYERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18704-1318
Practice Address - Country:US
Practice Address - Phone:570-283-3301
Practice Address - Fax:570-283-3304
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007884L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
54030Medicare ID - Type Unspecified
F33863Medicare UPIN