Provider Demographics
NPI:1154357259
Name:VITOLO-GALLO, EMILIA (MD)
Entity type:Individual
Prefix:
First Name:EMILIA
Middle Name:
Last Name:VITOLO-GALLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EMILIA
Other - Middle Name:
Other - Last Name:VITOLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:907 OLD FRITZTOWN RD
Mailing Address - Street 2:
Mailing Address - City:SINKING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:19608-9153
Mailing Address - Country:US
Mailing Address - Phone:610-670-7741
Mailing Address - Fax:
Practice Address - Street 1:ROUTE 422, SPORTSMAN ROAD
Practice Address - Street 2:BUILDING 37
Practice Address - City:WERNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19565-0300
Practice Address - Country:US
Practice Address - Phone:610-678-3411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036187E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE59957Medicare UPIN
585160Medicare PIN