Provider Demographics
NPI:1972542280
Name:GALLAGHER, THOMAS J (DO)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 ROUTE 168
Mailing Address - Street 2:WASHINGTON PROFESSIONAL CAMPUS II, SUITES 301-305
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-3210
Mailing Address - Country:US
Mailing Address - Phone:856-374-4031
Mailing Address - Fax:856-232-9139
Practice Address - Street 1:901 ROUTE 168
Practice Address - Street 2:WASHINGTON PROFESSIONAL CAMPUS II, SUITES 301-305
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-3210
Practice Address - Country:US
Practice Address - Phone:856-374-4031
Practice Address - Fax:856-232-9139
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB078345002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A3738029OtherOXFORD HEALTH
NJ0060119Medicaid
2360542000OtherAMERIHEALTH
60018627OtherHORIZON NJ HEALTH
P00431854OtherRAILROAD MEDICARE
A3738029OtherOXFORD HEALTH
2360542000OtherAMERIHEALTH