Provider Demographics
NPI:1962504134
Name:GALLIANI, CARLOS A (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:A
Last Name:GALLIANI
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:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-434-3626
Mailing Address - Fax:251-445-2464
Practice Address - Street 1:1700 CENTER ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-3301
Practice Address - Country:US
Practice Address - Phone:251-415-1612
Practice Address - Fax:251-415-1003
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0801207ZP0213X
ALMD.16891207ZP0213X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0213XAllopathic & Osteopathic PhysiciansPathologyPediatric Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10031612OtherAMERIGROUP PIN
TX0083EBOtherBCBSTX GRP PIN
TX124202OtherSUPERIOR PIN
1750369203OtherGRP NPI NUMBER
TX9136812OtherPHCS PIN
TX105723403Medicaid
TX105723404OtherCSHCN
TX113226100OtherFIRSTCARE PIN
TX1453326OtherUHC PIN
TX1864169OtherFIRSTHEALTH PIN
TX5781102OtherAETNA PIN
TX7414492OtherCIGNA PIN
TX85112YOtherBCBSTX IND PIN
TX1864169OtherFIRSTHEALTH PIN
8L20973Medicare PIN