Healthcare Provider Details

I. General information

NPI: 1932111390
Provider Name (Legal Business Name): SCOTT GALLAGHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3404 WAKE FOREST RD
RALEIGH NC
27609-7340
US

IV. Provider business mailing address

3404 WAKE FOREST RD
RALEIGH NC
27609-7340
US

V. Phone/Fax

Practice location:
  • Phone: 919-576-8155
  • Fax: 919-576-8154
Mailing address:
  • Phone: 919-576-8155
  • Fax: 919-576-8154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME86585
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2011-01979
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: