Basic Information
| Provider Information | |||||||||
| NPI: | 1801894829 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GALLAGHER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 33440 | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061503440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605227181 | ||||||||
| FaxNumber: | 8602783357 | ||||||||
| Practice Location | |||||||||
| Address1: | 114 WOODLAND ST | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061051208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607149333 | ||||||||
| FaxNumber: | 8607148612 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2005 | ||||||||
| LastUpdateDate: | 06/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | 026739 | CT | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 026739 | 01 | CT | CONNECTICARE | OTHER | 061028513 | 01 | CT | COMMUNITY HEALTH NTWK | OTHER | P1150301 | 01 | CT | OXFORD HEALTHPLAN | OTHER | 1604743 | 01 | CT | CIGNA HEALTHPLAN | OTHER | 010026739CT04 | 01 | CT | ANTHEM BLUECROSS/BS | OTHER | 4138731 | 01 | CT | AETNA HEALTHPLAN | OTHER | 010026739CT04 | 01 | CT | BLUECARE FAMILY PLAN | OTHER | 2806564 | 01 | CT | AETNA HMO | OTHER | 330004788 | 01 | CT | RAILROAD MEDICARE | OTHER | 001267394 | 05 | CT | MEDICAID | OV7703 | 01 | CT | HEALTHNET OF NE | OTHER |