Provider Demographics
NPI:1811982101
Name:GALLAGHER, GEORGEANNA M (CRNA)
Entity type:Individual
Prefix:
First Name:GEORGEANNA
Middle Name:M
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:CRNA
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 650782
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0782
Mailing Address - Country:US
Mailing Address - Phone:215-442-5085
Mailing Address - Fax:877-329-2370
Practice Address - Street 1:2010 W CHESTER PIKE
Practice Address - Street 2:STE 212
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-2700
Practice Address - Country:US
Practice Address - Phone:215-442-5085
Practice Address - Fax:877-329-2370
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN177257L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA033935OtherAANA ID
PAP00670052OtherRAILROAD MEDICARE
PA001956046Medicaid
PAP00670052OtherRAILROAD MEDICARE