Provider Demographics
NPI:1093702326
Name:GALLAGHER, EILEEN M (DO)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:M
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1108
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35056-1108
Mailing Address - Country:US
Mailing Address - Phone:256-737-2882
Mailing Address - Fax:256-737-2050
Practice Address - Street 1:307 MAIN ST SW
Practice Address - Street 2:
Practice Address - City:HANCEVILLE
Practice Address - State:AL
Practice Address - Zip Code:35077-5476
Practice Address - Country:US
Practice Address - Phone:256-352-4767
Practice Address - Fax:256-352-4797
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO285207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000094174Medicaid
AL51094174OtherBLUE CROSS
ALI168Medicare PIN
AL51094174OtherBLUE CROSS
ALF51003Medicare UPIN