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NPI Code Detail

MEDICARE: JOHN GALLAGHER M.D.

MEDICARE: JOHN GALLAGHER M.D.
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
1207V00000XObstetrics & Gynecology PhysicianVT 7040VT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100006013OTHERVTBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
35213101OTHERVTVERMONT MANAGED CARE
416V014OTHERVTMVP

General Provider Information

NPI Number : 1811974975
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN GALLAGHER M.D.
Provider Business Mailing Address
First Line : PO BOX 156
Second Line :
City : JERICHO
State : VT
Zip : 05465-0156
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 55 MAIN ST
Second Line : SUITE 3
City : ESSEX JUNCTION
State : VT
Zip : 05452-3191
Country : US
Telephone Number : 802-879-1802
Fax Number : 802-878-6131
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2005
Last Update Date : 07/08/2007

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