Provider Demographics
NPI:1487842084
Name:GALLOWAY, ABRAHAM S (MD)
Entity Type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:S
Last Name:GALLOWAY
Suffix:
Gender:M
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:PO BOX 23229
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42304-3229
Mailing Address - Country:US
Mailing Address - Phone:270-688-1330
Mailing Address - Fax:270-688-1338
Practice Address - Street 1:444 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431
Practice Address - Country:US
Practice Address - Phone:270-821-4444
Practice Address - Fax:270-824-6631
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41952207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100033030Medicaid
KY7100033030Medicaid
KY0745835Medicare PIN
KY0902409Medicare PIN
KY0935816Medicare PIN
KY00151035Medicare PIN
KY7100033030Medicaid
KY0683244Medicare PIN
KY00503012Medicare PIN
KY0374957Medicare PIN
KY0396862Medicare PIN
KY00280054Medicare PIN
KYP00473523Medicare PIN
KY0601452Medicare PIN
KY0952016Medicare PIN