Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | MD 025120E | PA |
NPI | 1023019239 |
---|---|
Provider Name | Dr. Philip Edward Gallagher |
First Address | Erie, PA 16505-4510 |
Second Address | Erie, PA 16505-4510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 04/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000808942 | (05) | PA |
10927188 | CAQH (01) |