Provider Demographics
NPI:1720058084
Name:GALLAGHER, EDWARD RAYMOND II
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:RAYMOND
Last Name:GALLAGHER
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 SEABEE DR
Mailing Address - Street 2:PHIBCB TWO
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23459-8917
Mailing Address - Country:US
Mailing Address - Phone:757-462-8710
Mailing Address - Fax:
Practice Address - Street 1:1815 SEABEE DR
Practice Address - Street 2:PHIBCB TWO
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23459-8917
Practice Address - Country:US
Practice Address - Phone:757-462-8710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians