Provider Demographics
NPI:1144613944
Name:GALLAGHER, KATHERINE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:MCGILLIVRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1771 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-1242
Mailing Address - Country:US
Mailing Address - Phone:723-364-2144
Mailing Address - Fax:732-364-3559
Practice Address - Street 1:1771 MADISON AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-1242
Practice Address - Country:US
Practice Address - Phone:732-364-2144
Practice Address - Fax:732-364-3559
Is Sole Proprietor?:No
Enumeration Date:2015-03-18
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA003521363AM0700X
PAMA057488363AM0700X
NJ25MP00542400363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical