Provider Demographics
NPI:1558348060
Name:GALLAGHER, DONNA M (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:M
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:39 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:BREEZY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11697-1110
Mailing Address - Country:US
Mailing Address - Phone:718-318-8595
Mailing Address - Fax:
Practice Address - Street 1:8268 164TH ST
Practice Address - Street 2:QUEEENS HOSPIAL CENTER-DEPT OF RADIOLOGY
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1121
Practice Address - Country:US
Practice Address - Phone:718-883-4400
Practice Address - Fax:718-883-6198
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1959192085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01591822Medicaid
529582Medicare Oscar/Certification
NYG08598Medicare UPIN