Provider Demographics
NPI:1851176804
Name:GALLO, ROSE MADELINE (RD, LD)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:MADELINE
Last Name:GALLO
Suffix:
Gender:
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15015 LANCASTER HWY
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2010
Mailing Address - Country:US
Mailing Address - Phone:302-547-5703
Mailing Address - Fax:
Practice Address - Street 1:15015 LANCASTER HWY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2010
Practice Address - Country:US
Practice Address - Phone:302-547-5703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL006235133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered