Provider Demographics
NPI:1255372876
Name:GALLO, RALPH C (MD)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:C
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 1:505 SUSSEX RD
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-2203
Mailing Address - Country:US
Mailing Address - Phone:610-649-1398
Mailing Address - Fax:
Practice Address - Street 1:505 SUSSEX RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-2203
Practice Address - Country:US
Practice Address - Phone:610-649-1398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016803E208000000X, 2080S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01540868Medicaid
PA01540868Medicaid
B96842Medicare UPIN
NJ067118PSPMedicare ID - Type Unspecified