Provider Demographics
NPI:1922109594
Name:SAMUEL A GALLO MD
Entity Type:Organization
Organization Name:SAMUEL A GALLO MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GALLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-766-5438
Mailing Address - Street 1:6620 PERIMETER DR STE 100A
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-8061
Mailing Address - Country:US
Mailing Address - Phone:614-766-5438
Mailing Address - Fax:614-408-8279
Practice Address - Street 1:6620 PERIMETER DR
Practice Address - Street 2:SUITE 100A
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-8055
Practice Address - Country:US
Practice Address - Phone:614-766-5438
Practice Address - Fax:614-408-8269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082087207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty