MEDICARE: DR. MARY BERNADETTE GALVIN 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
1	207RC0000X	Cardiovascular Disease Physician	173017	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922067818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY BERNADETTE GALVIN M.D.

Provider Business Mailing Address
First Line	:	1102 VICTORY BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-3622
Country	:	US
Telephone Number	:	718-447-5072
Fax Number	:	718-447-5178

Provider Business Practice Location Address
First Line	:	1102 VICTORY BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-3622
Country	:	US
Telephone Number	:	718-447-5072
Fax Number	:	718-447-5178

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	01/03/2011

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