Provider Demographics
NPI:1417956814
Name:GALLAGHER, MARY ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY ELLEN
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2501 N GLEBE RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-3558
Mailing Address - Country:US
Mailing Address - Phone:703-527-6664
Mailing Address - Fax:703-525-3451
Practice Address - Street 1:2501 N GLEBE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207-3558
Practice Address - Country:US
Practice Address - Phone:703-527-6664
Practice Address - Fax:703-527-0655
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01235679207R00000X
VA0123579208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7668476OtherAETNA PPO
VA2230846OtherGREAT WEST
VA30-0212850OtherVIRGINIA HEALTH NETWORK
VA30-0212850OtherPHCS
VA30-0212850OtherUNITED HEALTHCARE
VA4130006OtherMAMSI/ALLIANCE INT.MED.
VAJ828-0001OtherCAREFIRST BC/BS
VAJ828-0001OtherFEDERAL EMPLOYEES BC/BS
VA2130006OtherMAMSI/ALLIANCE PEDIATRIC
VA138532OtherANTHEM BC/BS
VA30-0212850OtherNCPPO
VA2230846OtherFIRST HEALTH
VA3555510OtherAETNA HMO
VA5539725OtherCCN
VA30-0212850OtherPHCS
VA3555510OtherAETNA HMO