Provider Demographics
NPI:1992747695
Name:GALLENSTEIN, GEORGE LEROY III (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:LEROY
Last Name:GALLENSTEIN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 OLD MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056-8928
Mailing Address - Country:US
Mailing Address - Phone:606-759-7878
Mailing Address - Fax:606-759-1808
Practice Address - Street 1:2003 OLD MAIN ST
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-8928
Practice Address - Country:US
Practice Address - Phone:606-759-7878
Practice Address - Fax:606-759-1808
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30607207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2131651Medicaid
KY64306079Medicaid
KY64306079Medicaid
KY0654701Medicare PIN
KY6547Medicare PIN