=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881901015
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. JAMES WILLIAM GALLAGHER
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2010
-----------------------------------------------------
Last Update Date | 03/17/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 41 MALL ROAD PROVIDER ENROLLMENT DEPT PROVIDER ENROLLMENT DEPT., 41 MALL ROAD
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01805-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-744-8085
-----------------------------------------------------
Fax | 781-744-5433
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 41 MALL ROAD PROVIDER ENROLLMENT DEPT LAHEY HOSPITAL AND MEDICAL CENTER
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01805-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-744-8085
-----------------------------------------------------
Fax | 781-744-5433
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------