Provider Demographics
NPI:1427147214
Name:GALLAGHER, MICHAEL RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RICHARD
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1010 E 3RD ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2109
Mailing Address - Country:US
Mailing Address - Phone:423-265-2233
Mailing Address - Fax:423-756-8265
Practice Address - Street 1:1010 E 3RD ST
Practice Address - Street 2:SUITE 202
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2109
Practice Address - Country:US
Practice Address - Phone:423-265-2233
Practice Address - Fax:423-756-8265
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD26400207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN140003990OtherRAILROAD MEDICARE
TN4313010001Medicare NSC
F87832Medicare UPIN
GA14BDCJJMedicare PIN
TN3090755Medicare PIN