Basic Information
| Provider Information | |||||||||
| NPI: | 1598760431 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GALLAGHER | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 N ACADEMY AVE | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178224903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702716144 | ||||||||
| FaxNumber: | 5702716578 | ||||||||
| Practice Location | |||||||||
| Address1: | 211 E 3RD ST | ||||||||
| Address2: | |||||||||
| City: | LEWISTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170441712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172427297 | ||||||||
| FaxNumber: | 7172427741 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2005 | ||||||||
| LastUpdateDate: | 08/25/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD-023494-E | PA | N | Other Service Providers | Specialist | 207RX0202X | MD023494E | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 2085R0203X | MD 023494 E | PA | N | Allopathic & Osteopathic Physicians | Radiology | Therapeutic Radiology | 2085R0001X | MD023494E | PA | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 5198607 | 05 | NJ | MEDICAID | 000926356 | 05 | PA | MEDICAID | 01155513 | 05 | NY | MEDICAID |