Provider Demographics
NPI:1720020688
Name:GALLO, SHEILA A (MD)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:A
Last Name:GALLO
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 1:2150 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104
Mailing Address - Country:US
Mailing Address - Phone:713-739-5676
Mailing Address - Fax:413-739-2278
Practice Address - Street 1:2150 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3300
Practice Address - Country:US
Practice Address - Phone:413-739-5676
Practice Address - Fax:413-739-2278
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA157337207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ19510OtherBLUE CROSS BLUE SHIELD
CT010157337MA01OtherBLUE CROSS BLUE SHIELD CT
MA3194469Medicaid
MA157337OtherTUFTS HEALTH PLAN
MA23397OtherHEALTH NEW ENGLAND
G44787Medicare UPIN
MAA28773Medicare ID - Type Unspecified