Provider Demographics
NPI:1770554966
Name:GALLUZZO, DOMINICK A (MD)
Entity type:Individual
Prefix:
First Name:DOMINICK
Middle Name:A
Last Name:GALLUZZO
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 1:1650 HUNTINGDON PIKE
Mailing Address - Street 2:SUITE 156
Mailing Address - City:MEADOWBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19046-8004
Mailing Address - Country:US
Mailing Address - Phone:215-947-7924
Mailing Address - Fax:215-947-0187
Practice Address - Street 1:1650 HUNTINGDON PIKE
Practice Address - Street 2:SUITE 156
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8004
Practice Address - Country:US
Practice Address - Phone:215-947-7924
Practice Address - Fax:215-947-0187
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424479207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1232853Medicaid
PAP00146649OtherRAILROAD MEDICARE
PAP00146649OtherRAILROAD MEDICARE
PAI11385Medicare UPIN
PA081151Medicare PIN