Healthcare Provider Details

I. General information

NPI: 1144721424
Provider Name (Legal Business Name): CAITLIN ANNE GALLAGHER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 02/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 WINDERMERE RD UNIVERSITY HOSPITAL DEPARTMENT OF ANESTHESIA
LONDON ONTARIO
N6A5A5
CV

IV. Provider business mailing address

204-221 ADELAIDE ST
SOUTHAMPTON ONTARIO
020
CA

V. Phone/Fax

Practice location:
  • Phone: 519-685-8500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number100275
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: