Provider Demographics
NPI:1770534380
Name:GALLO, GIAMPAOLO (MD)
Entity type:Individual
Prefix:
First Name:GIAMPAOLO
Middle Name:
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 1:158 MILLFORD XING
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-1177
Mailing Address - Country:US
Mailing Address - Phone:215-370-5767
Mailing Address - Fax:
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-2343
Practice Address - Country:US
Practice Address - Phone:215-370-5767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYMD2918912084P0800X
NY2918912084P0800X
PAMD072088L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD072088LOtherLICENSE NUMBER
PA0018742450001Medicaid
PA0018742450001Medicaid
PAH53674Medicare UPIN