Provider Demographics
NPI:1295923910
Name:GALLO, JULIE HELEN (PA-C)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:HELEN
Last Name:GALLO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7845 COLONY ROAD STE C4 #208
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226
Mailing Address - Country:US
Mailing Address - Phone:704-848-6260
Mailing Address - Fax:704-997-1395
Practice Address - Street 1:8035 PROVIDENCE RD STE 106
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-9716
Practice Address - Country:US
Practice Address - Phone:704-848-6260
Practice Address - Fax:704-997-1395
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001008612363A00000X
NC0010-08612363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAH176ZMedicare PIN
FLAH176YMedicare PIN
FLAH176YMedicare PIN