Provider Demographics
NPI:1629033261
Name:GALLEGO, MYRNA SOLIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MYRNA
Middle Name:SOLIS
Last Name:GALLEGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 WILLOW RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-3501
Mailing Address - Country:US
Mailing Address - Phone:716-691-4228
Mailing Address - Fax:716-691-3967
Practice Address - Street 1:18 WILLOW RIDGE DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-3501
Practice Address - Country:US
Practice Address - Phone:716-691-4228
Practice Address - Fax:716-691-3967
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118352207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB71584Medicare UPIN
NY074461Medicare PIN