Provider Demographics
NPI:1902060601
Name:DOMINGO E GALLIANO JR PA
Entity type:Organization
Organization Name:DOMINGO E GALLIANO JR PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINGO
Authorized Official - Middle Name:E
Authorized Official - Last Name:GALLIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-625-1033
Mailing Address - Street 1:18308 MURDOCK CIRCLE 108
Mailing Address - Street 2:DOMINGO E GALLIANO JR MD PA
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948
Mailing Address - Country:US
Mailing Address - Phone:941-625-1033
Mailing Address - Fax:941-625-1792
Practice Address - Street 1:18308 MURDOCK CIRCLE 108
Practice Address - Street 2:DOMINGO E GALLIANO JR MD PA
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948
Practice Address - Country:US
Practice Address - Phone:941-625-1033
Practice Address - Fax:941-625-1792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54294208600000X, 2086S0102X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0643Medicare PIN