Provider Demographics
NPI:1104813922
Name:GALANG, LEANDRO P (MD)
Entity type:Individual
Prefix:
First Name:LEANDRO
Middle Name:P
Last Name:GALANG
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 1:407 MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BELPRE
Mailing Address - State:OH
Mailing Address - Zip Code:45714-1615
Mailing Address - Country:US
Mailing Address - Phone:740-315-5706
Mailing Address - Fax:740-388-1665
Practice Address - Street 1:407 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-1615
Practice Address - Country:US
Practice Address - Phone:740-315-5706
Practice Address - Fax:740-388-1665
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10811207Q00000X
OH35086100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0055445000Medicaid
OH0991940Medicaid
WV0055445000Medicaid
OHP01428174OtherRAILROAD MEDICARE MHCPI
OH0769299OtherMEDICARE PTAN
OH4310291Medicare PIN
WV0769297Medicare PIN