Provider Demographics
NPI:1679383319
Name:GALLAGHER, MADISON MARIE (APN)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:MARIE
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 BAY RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08226-4439
Mailing Address - Country:US
Mailing Address - Phone:609-204-0434
Mailing Address - Fax:
Practice Address - Street 1:660 WOODBURY GLASSBORO RD STE 26A
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-3738
Practice Address - Country:US
Practice Address - Phone:856-218-4848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15241300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily