Provider Demographics
NPI:1033089255
Name:ASSALA, GALLUS ABOMO
Entity type:Individual
Prefix:
First Name:GALLUS
Middle Name:ABOMO
Last Name:ASSALA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 BROOKE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1859
Mailing Address - Country:US
Mailing Address - Phone:240-708-6848
Mailing Address - Fax:
Practice Address - Street 1:2314 BROOKE GROVE RD
Practice Address - Street 2:
Practice Address - City:MITCHELLVILLE
Practice Address - State:MD
Practice Address - Zip Code:20721-1859
Practice Address - Country:US
Practice Address - Phone:240-708-6848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-11
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator