Provider Demographics
NPI:1487248548
Name:GALLAMOZA, ROCKY DOMINIC (CRNP)
Entity type:Individual
Prefix:MR
First Name:ROCKY
Middle Name:DOMINIC
Last Name:GALLAMOZA
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BALLENGER CENTER DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-7096
Mailing Address - Country:US
Mailing Address - Phone:301-682-7213
Mailing Address - Fax:
Practice Address - Street 1:300 BALLENGER CENTER DR
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-7096
Practice Address - Country:US
Practice Address - Phone:301-682-7213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR180601363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily