Provider Demographics
NPI:1790775476
Name:GALLAGHER, MARTHA L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:L
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:ANESTHESIA ASSOCIATES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-3030
Practice Address - Fax:617-665-1091
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA72736207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA072736OtherTUFTS HEALTH PLAN
MAJ11588OtherBCBS MA
MA3085546Medicaid
MAJ11588Medicare ID - Type Unspecified
MA072736OtherTUFTS HEALTH PLAN
E97795Medicare UPIN