MEDICARE: MRS. MARY PATRICIA GALLAGHER RN

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	163WL0100X	Lactation Consultant (Registered Nurse)	R092261	MD

General Provider Information

NPI Number	:	1497755938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY PATRICIA GALLAGHER RN

Provider Business Mailing Address
First Line	:	5712 RIO VISTA DR
Second Line	:
City	:	DERWOOD
State	:	MD
Zip	:	20855-2433
Country	:	US
Telephone Number	:	301-330-0886
Fax Number	:

Provider Business Practice Location Address
First Line	:	5712 RIO VISTA DR
Second Line	:
City	:	DERWOOD
State	:	MD
Zip	:	20855-2433
Country	:	US
Telephone Number	:	301-330-0886
Fax Number	:

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

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	07/08/2007

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