Provider Demographics
NPI:1053592964
Name:GALLAGHER, JAMES JOSEPH III (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:JOSEPH
Last Name:GALLAGHER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:455 LEWIS AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451-2121
Mailing Address - Country:US
Mailing Address - Phone:203-634-1900
Mailing Address - Fax:203-237-8441
Practice Address - Street 1:455 LEWIS AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-2121
Practice Address - Country:US
Practice Address - Phone:203-634-1900
Practice Address - Fax:203-237-8441
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
CT507472086S0129X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1053592964OtherANTHTEM