Provider Demographics
NPI:1013909449
Name:GALLAGHER, JAMES JOSEPH JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:JOSEPH
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 1:85 SEYMOUR ST
Mailing Address - Street 2:SUITE 409
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5501
Mailing Address - Country:US
Mailing Address - Phone:860-522-4158
Mailing Address - Fax:860-524-2652
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:SUITE 409
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-522-4158
Practice Address - Fax:860-524-2652
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0220332086S0129X, 2085R0204X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT06-1406459OtherHMC, PPO
CT06-1406459OtherUNITED HEALTHCARE
CT06-1406459OtherCOLONIAL COOPERATIVE CARE
CT06-1406459OtherFOCUS
CT0S2190OtherHEALTH NET
CT06-1406459OtherMULTIPLAN
CT070447OtherCONNECTICARE
CT06-1406459OtherCORVEL
CT010022033CT01OtherANTHEM BCBS
CT001220334Medicaid
CT06-1406459OtherPRIVATE HEALTHCARE SYSTEM
CT06-1406459OtherNORTHEAST HEALTH DIRECT
CT12522OtherHEALTH NEW ENGLAND
CT783256OtherAETNA
CTP958509OtherOXFORD
CT0210721 001OtherCIGNA
CT06-1406459OtherGREAT-WEST HEALTHCARE
MA3163636Medicaid
CT06-1406459OtherPRIVATE HEALTHCARE SYSTEM
MA3163636Medicaid