1801894829 NPI number — ROBERT C GALLAGHER MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801894829 NPI number — ROBERT C GALLAGHER MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

GALLAGHER

Provider First Name:

ROBERT

Provider Middle Name:

C

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1801894829

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

06/15/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 33440

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

HARTFORD

Provider Business Mailing Address State Name:

CT

Provider Business Mailing Address Postal Code:

06150-3440

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

860-522-7181

Provider Business Mailing Address Fax Number:

860-278-3357

Provider First Line Business Practice Location Address:

114 WOODLAND ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

HARTFORD

Provider Business Practice Location Address State Name:

CT

Provider Business Practice Location Address Postal Code:

06105-1208

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

860-714-9333

Provider Business Practice Location Address Fax Number:

860-714-8612

Provider Enumeration Date:

07/13/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208G00000X , with the licence number:  026739 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 026739 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 061028513 . This is a "COMMUNITY HEALTH NTWK" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: P1150301 . This is a "OXFORD HEALTHPLAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 1604743 . This is a "CIGNA HEALTHPLAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 010026739CT04 . This is a "ANTHEM BLUECROSS/BS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 4138731 . This is a "AETNA HEALTHPLAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 010026739CT04 . This is a "BLUECARE FAMILY PLAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 2806564 . This is a "AETNA HMO" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 330004788 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 001267394 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
• Identifier: OV7703 . This is a "HEALTHNET OF NE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".