Provider Demographics
NPI:1922067818
Name:GALVIN, MARY BERNADETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:BERNADETTE
Last Name:GALVIN
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 1:1102 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3622
Mailing Address - Country:US
Mailing Address - Phone:718-447-5072
Mailing Address - Fax:718-447-5178
Practice Address - Street 1:1102 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3622
Practice Address - Country:US
Practice Address - Phone:718-447-5072
Practice Address - Fax:718-447-5178
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173017207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01598654Medicaid
NYF27840Medicare UPIN
NY01598654Medicaid
NY44F051Medicare PIN