Healthcare Provider Details

I. General information

NPI: 1396737250
Provider Name (Legal Business Name): ALLERGY & ASTHMA ASSOCIATES OF NORTHWESTERN PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 W 15TH ST
ERIE PA
16505-4510
US

IV. Provider business mailing address

2202 W 15TH ST
ERIE PA
16505-4510
US

V. Phone/Fax

Practice location:
  • Phone: 814-456-5341
  • Fax: 814-456-5647
Mailing address:
  • Phone: 814-456-5341
  • Fax: 814-456-5647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PHILIP E GALLAGHER
Title or Position: PHYSICIAN GENERAL PARTNER
Credential: MD
Phone: 814-456-5341