Provider Demographics
NPI:1679564355
Name:GALLERANI, PETER MARK (PHYSICIAN)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:MARK
Last Name:GALLERANI
Suffix:
Gender:M
Credentials:PHYSICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6311
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3112
Mailing Address - Country:US
Mailing Address - Phone:336-274-9617
Mailing Address - Fax:336-482-2177
Practice Address - Street 1:1331 NORTH ELM STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-6304
Practice Address - Country:US
Practice Address - Phone:336-274-9617
Practice Address - Fax:336-482-2177
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC358992085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC27180OtherPARTNERS
NC86356OtherMEDCOST
NC891157QMedicaid
NC300097575OtherRAILROAD MEDICARE
NC1607870OtherUNITED HEALTHCARE
NC1157QOtherBLUE CROSS BLUE SHIELD
VA1679564355Medicaid
NC891157QMedicaid
VA1679564355Medicaid