Provider Demographics
NPI:1922273267
Name:ROSS A GALLO, M. D., LLC
Entity Type:Organization
Organization Name:ROSS A GALLO, M. D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:A
Authorized Official - Last Name:GALLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-552-9015
Mailing Address - Street 1:1539 JACKSON AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-5868
Mailing Address - Country:US
Mailing Address - Phone:504-552-9015
Mailing Address - Fax:504-561-6088
Practice Address - Street 1:1539 JACKSON AVE STE 220
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-5868
Practice Address - Country:US
Practice Address - Phone:504-552-9015
Practice Address - Fax:504-561-6088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD 019325103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1923966Medicaid
LA5N202Medicare PIN
LAE50493Medicare UPIN