Individual
DR. JACQULYN GALLOWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
11783 ROCK LANDING DR, SUITE 202, NEWPORT NEWS, VA 23606-4431
(757) 668-6300
(757) 668-6310
Mailing address
11783 ROCK LANDING DR, SUITE 202, NEWPORT NEWS, VA 23606-4431
(757) 668-6300
(757) 668-6310
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101053437
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015100
ANTHEM
VA
01
—
4121007
AETNA
VA
01
—
541778786
TAX ID #
VA
01
—
56204
SENTARA OPTIMA
VA
01
—
600101779
CIGNA
VA
05
—
6728791
—
VA
01
—
859093
OPTIMUM
VA
Enumeration date
05/17/2006
Last updated
12/11/2012
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