Provider Demographics
NPI:1699880856
Name:GALLAGHER, RENATA C (MD)
Entity type:Individual
Prefix:DR
First Name:RENATA
Middle Name:C
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:550 16TH STREET, BOX 0706
Mailing Address - Street 2:FOURTH FLOOR
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143
Mailing Address - Country:US
Mailing Address - Phone:415-476-9997
Mailing Address - Fax:415-476-9976
Practice Address - Street 1:550 16TH STREET, BOX 0706
Practice Address - Street 2:FOURTH FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143
Practice Address - Country:US
Practice Address - Phone:415-476-9997
Practice Address - Fax:415-476-9976
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77290208000000X, 207SG0201X, 207SG0202X
CAA77296207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207SG0202XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Biochemical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO90334272Medicaid
CO90334272Medicaid