Provider Demographics
NPI:1699745554
Name:GALLO, LISA D (DPM)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:D
Last Name:GALLO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WESTMORELAND CROSSING ROUTE 30 EAST
Mailing Address - Street 2:UNIT 10
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601
Mailing Address - Country:US
Mailing Address - Phone:724-216-0317
Mailing Address - Fax:724-837-0271
Practice Address - Street 1:WESTMORELAND CROSSING ROUTE 30 EAST
Practice Address - Street 2:UNIT 10
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601
Practice Address - Country:US
Practice Address - Phone:724-216-0317
Practice Address - Fax:724-837-0271
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC0005501213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001894328Medicaid
PA001894328Medicaid
PA057915RHYMedicare ID - Type Unspecified