Provider Demographics
NPI:1235499153
Name:GALLAGHER, LISA ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
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:P.O. BOX 13579
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19612-3579
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:315 DARBY SQ
Practice Address - Street 2:
Practice Address - City:ELVERSON
Practice Address - State:PA
Practice Address - Zip Code:19520-9302
Practice Address - Country:US
Practice Address - Phone:610-898-5240
Practice Address - Fax:610-286-6760
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS018456207Q00000X
FLOS11967207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14U7POtherBCBS
PA103290355Medicaid
PA103290355Medicaid