Basic Information
| Provider Information | |||||||||
| NPI: | 1801817325 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GALLAGHER | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | PAUL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 GREEN WOODS LN | ||||||||
| Address2: | |||||||||
| City: | UNIONVILLE | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060851552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8603061377 | ||||||||
| FaxNumber: | 8606751120 | ||||||||
| Practice Location | |||||||||
| Address1: | 61 COOPER ST | ||||||||
| Address2: | |||||||||
| City: | AGAWAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010012149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137868000 | ||||||||
| FaxNumber: | 4137862124 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 03/12/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 031323 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 56204 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1801817325 | 01 | NPI | OTHER |