Provider Demographics
NPI:1669402384
Name:GALLO, COSTANTINO T (MD)
Entity type:Individual
Prefix:DR
First Name:COSTANTINO
Middle Name:T
Last Name:GALLO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:173 N MORRISON AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2712
Mailing Address - Country:US
Mailing Address - Phone:408-293-1992
Mailing Address - Fax:408-293-0213
Practice Address - Street 1:173 N MORRISON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2712
Practice Address - Country:US
Practice Address - Phone:408-293-1992
Practice Address - Fax:408-293-0213
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2016-08-17
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Provider Licenses
StateLicense IDTaxonomies
CAG36983207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA060040239OtherMEDICARE RR
CAA46895Medicare UPIN
CA00G369832Medicare PIN