Provider Demographics
NPI:1356719561
Name:ALLERGY & ASTHMA OF NORTHWESTERN PENNSYLVANIA, LLC
Entity type:Organization
Organization Name:ALLERGY & ASTHMA OF NORTHWESTERN PENNSYLVANIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-456-5341
Mailing Address - Street 1:2202 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4510
Mailing Address - Country:US
Mailing Address - Phone:814-456-5341
Mailing Address - Fax:814-456-5647
Practice Address - Street 1:2202 W 15TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4510
Practice Address - Country:US
Practice Address - Phone:814-456-5341
Practice Address - Fax:814-456-5647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-03
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025120E207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty