Provider Demographics
NPI:1780874610
Name:GALLAGHER, EMILY ROSE (MD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ROSE
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ROSE
Other - Last Name:BOROD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3181 SW SAM JACKSON PARK BLVD
Mailing Address - Street 2:OHSU, DEPARTMENT OF PEDIATRICS
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239
Mailing Address - Country:US
Mailing Address - Phone:503-494-6513
Mailing Address - Fax:
Practice Address - Street 1:3181 SW SAM JACKSON PARK BLVD
Practice Address - Street 2:OHSU, DEPARTMENT OF PEDIATRICS
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239
Practice Address - Country:US
Practice Address - Phone:503-494-6513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML20008920208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics