Provider Demographics
NPI:1871956367
Name:GALLAGHER, BRIAN
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 S SHIRLINGTON RD FL 11
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-3601
Mailing Address - Country:US
Mailing Address - Phone:703-892-6500
Mailing Address - Fax:703-647-4645
Practice Address - Street 1:2800 S SHIRLINGTON RD FL 11
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-3601
Practice Address - Country:US
Practice Address - Phone:703-892-6500
Practice Address - Fax:703-647-4645
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-01
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101274396207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Single Specialty