Provider Demographics
NPI:1770560781
Name:GALLAGHER, KATHLEEN K (PA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:K
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:1221 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1561
Mailing Address - Country:US
Mailing Address - Phone:781-340-1702
Mailing Address - Fax:781-340-0931
Practice Address - Street 1:1221 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1561
Practice Address - Country:US
Practice Address - Phone:781-340-1702
Practice Address - Fax:781-340-0931
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2014-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA780363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP31634Medicare UPIN
MAAP1470Medicare PIN