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NPI Code Detail

MEDICARE: MARK JOSEPH GALLOWAY PA-C

MEDICARE: MARK JOSEPH GALLOWAY PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA100036000WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1137313OTHERWALABOR AND INDUSTRIES
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518965375
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK JOSEPH GALLOWAY PA-C
Provider Business Mailing Address
First Line : 2185 N FRASER ST
Second Line :
City : GEORGETOWN
State : SC
Zip : 29440-6418
Country : US
Telephone Number : 843-527-1800
Fax Number : 843-527-6528
Provider Business Practice Location Address
First Line : 2185 N FRASER ST
Second Line :
City : GEORGETOWN
State : SC
Zip : 29440-6418
Country : US
Telephone Number : 843-527-1800
Fax Number : 843-527-6528
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2005
Last Update Date : 09/26/2013

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