Individual provider Active NPI

Joseph David Gallego, MD

  • Child & Adolescent Psychiatry Physician
  • Boston, MA
National Provider Identifier
1104288406
Registry record updated Mar 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
291328 Issued in MA
Practice address
28 Atlantic Ave Ste 226
Boston, MA 02110-3820
Phone
(507) 215-4647
Fax
(769) 206-4623
NPI assigned
Mar 25, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry Physician 2084P0804X 56096 KY
Child & Adolescent Psychiatry Physician 2084P0804X 298743 NY
Child & Adolescent Psychiatry Physician 2084P0804X 25MA11418100 NJ
Child & Adolescent Psychiatry Physician 2084P0804X 61592 CT
Child & Adolescent Psychiatry Physician 2084P0804X 291328 MA Primary

Addresses

Primary practice location

28 Atlantic Ave Ste 226
Boston, MA 02110-3820

Mailing address

28 Atlantic Ave Ste 226
Boston, MA 02110-3820
Phone (507) 215-4647

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250212003503 MA Practitioner - Psychiatry 0042506537 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
61592CTMDChild & Adolescent Psychiatry Physician
56096KYMDChild & Adolescent Psychiatry Physician
25MA11418100NJMDChild & Adolescent Psychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Massachusetts General Physicians Organization Inc Psychiatry CurrentSince Feb 5, 2025 Accepting new patients
The General Hospital Corporation CurrentSince Feb 5, 2025 Accepting new patients

Locations

55 Fruit St
Boston, MA 02114

55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967

62 13th St
Charlestown, MA 02129
Phone (617) 724-4260

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1458864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742774400000",
    "number": "1104288406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 ATLANTIC AVE STE 226",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021103820",
            "telephone_number": "507-215-4647",
            "fax_number": "769-206-4623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 ATLANTIC AVE STE 226",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021103820",
            "telephone_number": "507-215-4647",
            "fax_number": "769-206-4623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLEGO",
        "first_name": "JOSEPH",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-25",
        "last_updated": "2025-03-24",
        "certification_date": "2025-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "KY",
            "license": "56096",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NY",
            "license": "298743",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NJ",
            "license": "25MA11418100",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "CT",
            "license": "61592",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "MA",
            "license": "291328",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.