Provider Demographics
NPI:1023019239
Name:GALLAGHER, PHILIP EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:EDWARD
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4510
Mailing Address - Country:US
Mailing Address - Phone:814-456-5341
Mailing Address - Fax:814-456-5647
Practice Address - Street 1:2202 W 15TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4510
Practice Address - Country:US
Practice Address - Phone:814-456-5341
Practice Address - Fax:814-456-5647
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2021-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 025120E207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000808942Medicaid
10927188OtherCAQH
368258OtherHEALTHAMERICA/COVENTRY
000108837OtherHIGHMARKBLUE SHIELD/CROSS
00025219101OtherUNIVERA
PA108837Medicare PIN