Provider Demographics
NPI:1548202534
Name:GALLOUSIS, GREGORY M (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:M
Last Name:GALLOUSIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:999 SUMMER STREET
Mailing Address - Street 2:SUITE 105
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5546
Mailing Address - Country:US
Mailing Address - Phone:203-359-2020
Mailing Address - Fax:203-325-4482
Practice Address - Street 1:999 SUMMER STREET
Practice Address - Street 2:SUITE 105
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5546
Practice Address - Country:US
Practice Address - Phone:203-359-2020
Practice Address - Fax:203-325-4482
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2018-04-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT044280207WX0009X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG37450Medicare UPIN