MR. GALLUS LEREH FOTABONG NPI 1821755513

NPI Information

NPI: 1821755513
Provider Name: MR. GALLUS LEREH FOTABONG
Classification: Nurse Practitioner - 363LG0600X
Entity Type: Individual

Specialization: Gerontology

PECOS Registration: Yes

Address:
41 HARVEST ST
LYNN, MA
ZIP 01902
Phone: (781) 244-8473
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MR. Gallus Lereh Fotabong is a gerontology nurse practitioner in Lynn, MA. MR. Gallus Lereh Fotabong NPI is 1821755513. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

41 HARVEST ST
LYNN, MA
ZIP 01902-122
Phone: (781) 244-8473

The NPI 1821755513 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 11/17/2021 and was last updated on 11/17/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LG0600X	Nurse Practitioner	Gerontology	AG11210066	MASSACHUSETTS	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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