Provider Demographics
NPI:1871607549
Name:GALLAGHER, ANN MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:MARIE
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8450 BALTIMORE NATIONAL PIKE STE 155
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3909
Mailing Address - Country:US
Mailing Address - Phone:410-465-6166
Mailing Address - Fax:410-465-8898
Practice Address - Street 1:8450 BALTIMORE NATIONAL PIKE STE 155
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3909
Practice Address - Country:US
Practice Address - Phone:410-465-6166
Practice Address - Fax:410-465-8898
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1309152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11248211OtherCAQH
11248211OtherCAQH
U60744Medicare UPIN