Provider Demographics
NPI:1477600161
Name:GALLO, DEBORAH L (DO)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:L
Last Name:GALLO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6730 HOLABIRD AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21222-1700
Mailing Address - Country:US
Mailing Address - Phone:410-288-6226
Mailing Address - Fax:410-288-9048
Practice Address - Street 1:6730 HOLABIRD AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21222-1743
Practice Address - Country:US
Practice Address - Phone:410-288-6226
Practice Address - Fax:410-288-9048
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0055992207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD110212671OtherMEDICARE RAILROAD
MD156603200Medicaid
MD7166165OtherAETNA PLANS
MDE268-0004OtherFEDERAL BLUE SHIELD
MD60635501OtherBLUE SHEILD OF MD
MDH17990Medicare UPIN
MD156603200Medicaid