Provider Demographics
NPI:1578501243
Name:GALLANT, JOEL EMANUEL (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:EMANUEL
Last Name:GALLANT
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 HARKLE RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4765
Mailing Address - Country:US
Mailing Address - Phone:410-989-8200
Mailing Address - Fax:
Practice Address - Street 1:649 HARKLE RD
Practice Address - Street 2:SUITE E
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4765
Practice Address - Country:US
Practice Address - Phone:410-989-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD38398207RI0200X
NMMD2012-0893207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD326471800Medicaid
MD326471800Medicaid
MDKR70MJ24Medicare PIN