Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | DO00947 | RI |
Y | 207RA0401X | Internist - Addiction Medicine | DO3075 | ME |
NPI | 1629465208 |
---|---|
Provider Name | Nicholas Gallagher |
First Address | Augusta, ME 04330-8160 |
Second Address | Augusta, ME 04330-8160 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2015 |
Last Update Date | 13/01/2021 |