Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 244654 | NY |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD428807 | PA |
NPI | 1235356379 |
---|---|
Provider Name | Dr. Robert August Gallo |
First Address | Hershey, PA 17033-2036 |
Second Address | Hershey, PA 17033-2036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 10/09/2008 |