Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 11865 | MA |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 11865 | MA |
NPI | 1942291489 |
---|---|
Provider Name | Dr. George Thomas Gallagher |
First Address | Charlestown, MA 02129-9142 |
Second Address | Boston, MA 02118-2651 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U47791 | (02) | |
X04285 | BLUE CROSS AND BLUE SHIEL (01) | MA |