Provider Demographics
NPI:1255781225
Name:MONTEALEGRE GALLEGOS, MARIO ERNESTO (MD)
Entity type:Individual
Prefix:
First Name:MARIO ERNESTO
Middle Name:
Last Name:MONTEALEGRE GALLEGOS
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 1:333 CEDAR ST DEPT OF
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3206
Mailing Address - Country:US
Mailing Address - Phone:617-459-5524
Mailing Address - Fax:
Practice Address - Street 1:330 BROOKLINE AVE # RABB239
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-5048
Practice Address - Fax:617-667-5050
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT63039207LC0200X, 207L00000X
MA268546390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program