Provider Demographics
NPI:1528082385
Name:GALLAGHER, PAMELA M (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:M
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:190 E JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2033
Mailing Address - Country:US
Mailing Address - Phone:516-977-9922
Mailing Address - Fax:516-977-9926
Practice Address - Street 1:190 E JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2033
Practice Address - Country:US
Practice Address - Phone:516-977-9922
Practice Address - Fax:516-977-9926
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY124739208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC05403Medicare UPIN
NY10A941Medicare ID - Type Unspecified