Healthcare Provider Details

I. General information

NPI: 1568881167
Provider Name (Legal Business Name): BRIDGET MARIE GALLAGHER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8877 MENTOR AVE
MENTOR OH
44060-6211
US

IV. Provider business mailing address

8877 MENTOR AVE
MENTOR OH
44060-6211
US

V. Phone/Fax

Practice location:
  • Phone: 440-205-1225
  • Fax: 440-205-1275
Mailing address:
  • Phone: 440-205-1225
  • Fax: 440-205-1275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35.143114
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: