Provider Demographics
NPI:1154697027
Name:GARGIULO, RICHARD THOMAS (DO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:THOMAS
Last Name:GARGIULO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:
Other - Last Name:GARGIULO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:101 E OLNEY AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2470
Mailing Address - Country:US
Mailing Address - Phone:215-456-7000
Mailing Address - Fax:215-456-5926
Practice Address - Street 1:5401 OLD YORK RD STE 505
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3047
Practice Address - Country:US
Practice Address - Phone:215-456-6970
Practice Address - Fax:215-456-7154
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036138386207RN0300X
PAOS021403207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology