Provider Demographics
NPI:1841579497
Name:GALLO, SEBASTIAN JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:SEBASTIAN
Middle Name:JOHN
Last Name:GALLO
Suffix:
Gender:M
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 ROBETH LN
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-3552
Mailing Address - Country:US
Mailing Address - Phone:860-529-3767
Mailing Address - Fax:
Practice Address - Street 1:18 ROBETH LN
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-3552
Practice Address - Country:US
Practice Address - Phone:860-529-3767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT010471208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice