Provider Demographics
NPI:1508840869
Name:GALLAGHER-BRAUN, JUDITH E
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:E
Last Name:GALLAGHER-BRAUN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:JUDITH
Other - Middle Name:E
Other - Last Name:GALLAGHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3 CORNERSTONE DRIVE - 670 WOODBOURNE ROAD
Mailing Address - Street 2:SUITE 703
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1219
Mailing Address - Country:US
Mailing Address - Phone:267-689-1000
Mailing Address - Fax:267-689-1008
Practice Address - Street 1:3 CORNERSTONE DR STE 703
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1320
Practice Address - Country:US
Practice Address - Phone:267-689-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD054428L207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G47459Medicare UPIN
PAGA898766Medicare ID - Type Unspecified