Provider Demographics
NPI:1316017437
Name:GALANTE, MARY ELLEN (CNM)
Entity type:Individual
Prefix:
First Name:MARY ELLEN
Middle Name:
Last Name:GALANTE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELLEN
Other - Last Name:GALANTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:IBCLC
Mailing Address - Street 1:1493 CAMBRIDGE ST
Mailing Address - Street 2:OB-GYN DEPARTMENT
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-1047
Mailing Address - Country:US
Mailing Address - Phone:617-665-1660
Mailing Address - Fax:
Practice Address - Street 1:1493 CAMBRIDGE ST
Practice Address - Street 2:OB-GYN DEPARTMENT
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1047
Practice Address - Country:US
Practice Address - Phone:617-665-1660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN193426163WL0100X
MA193426367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110016279AMedicaid
MA110016279AMedicaid