Provider Demographics
NPI:1952464356
Name:GALLAGHER, MARTIN WILLIAM JR (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:WILLIAM
Last Name:GALLAGHER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 CHARTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-3460
Mailing Address - Country:US
Mailing Address - Phone:301-797-0494
Mailing Address - Fax:
Practice Address - Street 1:124 E BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6104
Practice Address - Country:US
Practice Address - Phone:301-739-7748
Practice Address - Fax:866-343-0694
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDOO31880207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine