Provider Demographics
NPI:1801894829
Name:GALLAGHER, ROBERT C (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 33440
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06150-3440
Mailing Address - Country:US
Mailing Address - Phone:860-522-7181
Mailing Address - Fax:860-278-3357
Practice Address - Street 1:114 WOODLAND ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1208
Practice Address - Country:US
Practice Address - Phone:860-714-9333
Practice Address - Fax:860-714-8612
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT026739208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT026739OtherCONNECTICARE
CT061028513OtherCOMMUNITY HEALTH NTWK
CTP1150301OtherOXFORD HEALTHPLAN
CT1604743OtherCIGNA HEALTHPLAN
CT010026739CT04OtherANTHEM BLUECROSS/BS
CT4138731OtherAETNA HEALTHPLAN
CT010026739CT04OtherBLUECARE FAMILY PLAN
CT2806564OtherAETNA HMO
CT330004788OtherRAILROAD MEDICARE
CT001267394Medicaid
CTOV7703OtherHEALTHNET OF NE
CT1604743OtherCIGNA HEALTHPLAN
CT001267394Medicaid