Provider Demographics
NPI:1033290945
Name:GALLAGHER, MARILEE (MD)
Entity Type:Individual
Prefix:
First Name:MARILEE
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:440-974-4411
Mailing Address - Fax:440-974-4173
Practice Address - Street 1:9000 MENTOR AVE STE 100
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4496
Practice Address - Country:US
Practice Address - Phone:440-974-4411
Practice Address - Fax:440-974-4173
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044709G207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0433918Medicaid
OH0433918Medicaid