Provider Demographics
NPI:1013978741
Name:GALLAGHER, LAURIE A (DO)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:412 CREAMERY WAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2551
Mailing Address - Country:US
Mailing Address - Phone:610-594-7590
Mailing Address - Fax:610-594-2625
Practice Address - Street 1:142 WALLACE AVE STE 201
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335
Practice Address - Country:US
Practice Address - Phone:610-873-2700
Practice Address - Fax:610-594-2625
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2018-05-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS-009935-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH42735Medicare UPIN