Provider Demographics
NPI:1588128664
Name:GALLAGHER, MARLANA (MAOM)
Entity type:Individual
Prefix:
First Name:MARLANA
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46860 HILTON DR APT 1014
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20653-3729
Mailing Address - Country:US
Mailing Address - Phone:401-451-8200
Mailing Address - Fax:
Practice Address - Street 1:22530 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-3898
Practice Address - Country:US
Practice Address - Phone:240-718-8332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02558171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist