MEDICARE: DR. MARY ELLEN GALLAGHER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	01235679	VA
2	208000000X	Pediatrics Physician	0123579	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7668476	OTHER	VA	AETNA PPO
2	2230846	OTHER	VA	GREAT WEST
3	30-0212850	OTHER	VA	VIRGINIA HEALTH NETWORK
4	30-0212850	OTHER	VA	PHCS
5	30-0212850	OTHER	VA	UNITED HEALTHCARE
6	4130006	OTHER	VA	MAMSI/ALLIANCE INT.MED.
7	J828-0001	OTHER	VA	CAREFIRST BC/BS
8	J828-0001	OTHER	VA	FEDERAL EMPLOYEES BC/BS
9	2130006	OTHER	VA	MAMSI/ALLIANCE PEDIATRIC
10	138532	OTHER	VA	ANTHEM BC/BS
11	30-0212850	OTHER	VA	NCPPO
12	2230846	OTHER	VA	FIRST HEALTH
13	3555510	OTHER	VA	AETNA HMO
14	5539725	OTHER	VA	CCN

General Provider Information

NPI Number	:	1417956814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY ELLEN GALLAGHER M.D.

Provider Business Mailing Address
First Line	:	2501 N GLEBE RD
Second Line	:	SUITE 301
City	:	ARLINGTON
State	:	VA
Zip	:	22207-3558
Country	:	US
Telephone Number	:	703-527-6664
Fax Number	:	703-525-3451

Provider Business Practice Location Address
First Line	:	2501 N GLEBE RD
Second Line	:	SUITE 301
City	:	ARLINGTON
State	:	VA
Zip	:	22207-3558
Country	:	US
Telephone Number	:	703-527-6664
Fax Number	:	703-527-0655

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	04/17/2013

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