Provider Demographics
NPI:1609984509
Name:GALLO, DAVID S (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:GALLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:420 SAYBROOK RD
Mailing Address - Street 2:MIDDLESEX CARDIOLOGY ASSOCIATES
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4747
Mailing Address - Country:US
Mailing Address - Phone:860-347-4258
Mailing Address - Fax:860-704-5924
Practice Address - Street 1:420 SAYBROOK RD
Practice Address - Street 2:MIDDLESEX CARDIOLOGY ASSOCIATES
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4747
Practice Address - Country:US
Practice Address - Phone:860-347-4258
Practice Address - Fax:860-704-5924
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT035154207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
P1300962OtherOXFORD
010035154CT02OtherANTHEM
021161OtherHEALTH NET
0000139483406OtherUNITED HC
3956861002OtherCIGNA
734714OtherCT
CT001351543Medicaid
2093205OtherAETNA
00135154301OtherEDS BLUE CARE
010035154CT02OtherANTHEM
G27695Medicare UPIN