Provider Demographics
NPI:1811217375
Name:GALLO, ANTHONY JAMES (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JAMES
Last Name:GALLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2648
Mailing Address - Street 2:RAD: DIAGNOSTIC
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502
Mailing Address - Country:US
Mailing Address - Phone:606-432-1357
Mailing Address - Fax:606-432-2457
Practice Address - Street 1:161 COLLEGE ST STE 1
Practice Address - Street 2:RAD: DIAGNOSTIC
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-4786
Practice Address - Country:US
Practice Address - Phone:606-432-1357
Practice Address - Fax:606-432-2457
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY464052085R0202X
VA0101247174390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2014248664Medicaid
KY7100297390OtherKENTUCKY MEDICAID
KY986408OtherWELLCARE OF KENTUCKY
KY304018OtherCOVENTRY
WV3810028087OtherMOLINA WEST VA MAA
KY000000872442OtherANTHEM
KYP01342718OtherPALMETTO GBA
KYP01342718OtherPALMETTO GBA