Provider Demographics
NPI:1780622449
Name:GALLO, ANTHONY LOUIS JR (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:LOUIS
Last Name:GALLO
Suffix:JR
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 1:420 SCRABBLETOWN RD STE A
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-3638
Mailing Address - Country:US
Mailing Address - Phone:401-268-5333
Mailing Address - Fax:401-268-5330
Practice Address - Street 1:420 SCRABBLETOWN RD STE A
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-3638
Practice Address - Country:US
Practice Address - Phone:401-268-5333
Practice Address - Fax:401-268-5330
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2005352084P0800X
RIMD117672084P0800X, 2084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA616882OtherTUFTS
MA2082811Medicaid
MA42258OtherHEALTHNET
MAJ40884OtherBLUE CROSS
MA616882OtherTUFTS
106479Medicare UPIN
MAA36781Medicare PIN