Provider Demographics
NPI:1568881167
Name:GALLAGHER, BRIDGET MARIE (MD)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:MARIE
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8877 MENTOR AVE
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6211
Mailing Address - Country:US
Mailing Address - Phone:440-205-1225
Mailing Address - Fax:440-205-1275
Practice Address - Street 1:8877 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6211
Practice Address - Country:US
Practice Address - Phone:440-205-1225
Practice Address - Fax:440-205-1275
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.143114207RG0100X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program