Provider Demographics
NPI:1902865181
Name:GALLAGHER, KEVIN F (DPM)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:F
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-3063
Mailing Address - Country:US
Mailing Address - Phone:724-941-4330
Mailing Address - Fax:412-381-8690
Practice Address - Street 1:3515 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-3063
Practice Address - Country:US
Practice Address - Phone:724-941-4330
Practice Address - Fax:412-381-8690
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002436L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011427080004Medicaid
PAT28654Medicare UPIN
PA546370Medicare ID - Type Unspecified