Basic Information
Provider Information
NPI: 1144208810
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GALLON
FirstName: RAYMOND
MiddleName: M
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9335 MCKNIGHT RD FL 1
Address2:  
City: PITTSBURGH
State: PA
PostalCode: 152375903
CountryCode: US
TelephoneNumber: 4128472020
FaxNumber: 4128472025
Practice Location
Address1: 9335 MCKNIGHT RD FL 1
Address2:  
City: PITTSBURGH
State: PA
PostalCode: 152375903
CountryCode: US
TelephoneNumber: 4128472020
FaxNumber: 4128472025
Other Information
ProviderEnumerationDate: 01/04/2006
LastUpdateDate: 10/13/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/13/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMD419856PAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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