Individual
JACQUELINE GALLAGHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
130 FISHER RD, EMERGENCY DEPT, BERLIN, VT 05602-9516
(802) 371-4365
(802) 371-4481
Mailing address
PO BOX 547, ATT: CVMC FINANCE DEPT, BARRE, VT 05641-0547
(802) 371-4365
(802) 371-4481
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
055.0031114
VT
363A00000X
Physician Assistant
586
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9000545
—
VT
Enumeration date
05/03/2006
Last updated
12/15/2014
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