Provider Demographics
NPI:1194778464
Name:GALLAGHER, KEVIN ANDREW (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:ANDREW
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CAREY RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-7880
Mailing Address - Country:US
Mailing Address - Phone:518-761-0300
Mailing Address - Fax:518-824-2388
Practice Address - Street 1:24 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:SCHROON LAKE
Practice Address - State:NY
Practice Address - Zip Code:12870-0292
Practice Address - Country:US
Practice Address - Phone:518-532-7120
Practice Address - Fax:518-532-0593
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY235580207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02753006Medicaid
NYP00393876OtherRR MEDICARE
I52844Medicare UPIN
NY02753006Medicaid