Provider Demographics
NPI:1588612683
Name:GALLAGHER, JOHN T (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:GALLAGHER
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 1:105 MILLBURY ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-3205
Mailing Address - Country:US
Mailing Address - Phone:508-832-9691
Mailing Address - Fax:
Practice Address - Street 1:604 MAIN STREET
Practice Address - Street 2:CHILD HEALTH ASSOCIATES
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545
Practice Address - Country:US
Practice Address - Phone:508-845-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220037208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics