Provider Demographics
NPI:1881637965
Name:GALLAGHER, EDWARD J (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 8505
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-0505
Mailing Address - Country:US
Mailing Address - Phone:856-755-1616
Mailing Address - Fax:856-755-0098
Practice Address - Street 1:1600 HADDON AVE
Practice Address - Street 2:ROOM 122
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-3101
Practice Address - Country:US
Practice Address - Phone:856-757-3879
Practice Address - Fax:856-757-3760
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA03779100208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1081543OtherHORIZON NJ HEALTH
1095619001OtherCIGNA
4238146OtherAETNA
824095OtherCCN
F01765OtherHEALTHNET
JS181OtherOXFORD
63810OtherPA BLUE SHIELD
NJ2180103Medicaid
30017393OtherKEYSTONE MERCY
NJ0075655000OtherAMERIHEALTH / KEYSTONE
19073OtherMHCS
NJ063810AHSMedicare ID - Type Unspecified