Provider Demographics
NPI:1144295189
Name:GALLAGHER, MARTIN P (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:P
Last Name:GALLAGHER
Suffix:
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 1:6402 RT 30
Mailing Address - Street 2:
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644
Mailing Address - Country:US
Mailing Address - Phone:724-523-5505
Mailing Address - Fax:724-527-6413
Practice Address - Street 1:6402 RT 30
Practice Address - Street 2:
Practice Address - City:JEANNETTE
Practice Address - State:PA
Practice Address - Zip Code:15644
Practice Address - Country:US
Practice Address - Phone:724-523-5505
Practice Address - Fax:724-527-6413
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001626L111N00000X
PAMD433329207Q00000X
OH89802207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T72377Medicare UPIN
027643LHIMedicare ID - Type Unspecified