Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 50747 | CT |
NPI | 1053592964 |
---|---|
Provider Name | James Joseph Gallagher III |
First Address | Meriden, CT 06451-2121 |
Second Address | Meriden, CT 06451-2121 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2007 |
Last Update Date | 11/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1053592964 | ANTHTEM (01) | CT |