Provider Demographics
NPI:1740591916
Name:GALLOWAY, TABITHA LYNN IRELAND (MD)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:LYNN IRELAND
Last Name:GALLOWAY
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 1:9500 EUCLID AVE # A71
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-444-4949
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL DR # MA314
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-5276
Practice Address - Country:US
Practice Address - Phone:573-882-6737
Practice Address - Fax:573-884-4205
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010018489207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology