1417956814 NPI number — DR. MARY ELLEN GALLAGHER M.D.

Table of content: TAMMY STANLEY AIDE (NPI 1205562261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417956814 NPI number — DR. MARY ELLEN GALLAGHER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GALLAGHER
Provider First Name:
MARY ELLEN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

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 Information

NPI Number:
1417956814
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2501 N GLEBE RD
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22207-3558
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-527-6664
Provider Business Mailing Address Fax Number:
703-525-3451

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2501 N GLEBE RD
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22207-3558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-527-6664
Provider Business Practice Location Address Fax Number:
703-527-0655
Provider Enumeration Date:
07/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  01235679 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: 0123579 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7668476 . This is a "AETNA PPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2230846 . This is a "GREAT WEST" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 30-0212850 . This is a "VIRGINIA HEALTH NETWORK" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 30-0212850 . This is a "PHCS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 30-0212850 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4130006 . This is a "MAMSI/ALLIANCE INT.MED." identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: J828-0001 . This is a "CAREFIRST BC/BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: J828-0001 . This is a "FEDERAL EMPLOYEES BC/BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2130006 . This is a "MAMSI/ALLIANCE PEDIATRIC" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 138532 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 30-0212850 . This is a "NCPPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2230846 . This is a "FIRST HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 3555510 . This is a "AETNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5539725 . This is a "CCN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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