Provider Demographics
NPI:1942291489
Name:GALLAGHER, GEORGE THOMAS (DMD DMSC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:THOMAS
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:DMD DMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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 1:100 E NEWTON ST
Practice Address - Street 2:G 04
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2651
Practice Address - Country:US
Practice Address - Phone:617-638-4808
Practice Address - Fax:617-638-4697
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA118651223P0106X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX04285OtherBLUE CROSS AND BLUE SHIEL
U47791Medicare UPIN
MAX04285OtherBLUE CROSS AND BLUE SHIEL