Provider Demographics
NPI:1104090232
Name:GALLAGHER, DAVID JASON (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JASON
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:346 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2580
Mailing Address - Country:US
Mailing Address - Phone:607-729-8156
Mailing Address - Fax:607-729-2209
Practice Address - Street 1:33 MITCHELL AVE
Practice Address - Street 2:SUITE G-50
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903-1619
Practice Address - Country:US
Practice Address - Phone:607-771-2220
Practice Address - Fax:607-771-2225
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY246979207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03355662Medicaid
NY03355662Medicaid