Provider Demographics
NPI:1306091319
Name:GAGLIANO, RICK F (CP)
Entity type:Individual
Prefix:MR
First Name:RICK
Middle Name:F
Last Name:GAGLIANO
Suffix:
Gender:M
Credentials:CP
Other - Prefix:MR
Other - First Name:FEDRICK
Other - Middle Name:R
Other - Last Name:GAGLIANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CP
Mailing Address - Street 1:PO BOX 5066
Mailing Address - Street 2:CAROLINA ORTHO PROSTHETICS INC
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27835-5066
Mailing Address - Country:US
Mailing Address - Phone:252-752-1253
Mailing Address - Fax:252-757-3058
Practice Address - Street 1:2500 WEST 5TH STREET
Practice Address - Street 2:CAROLINA ORTHO PROSTHETICS INC
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7812
Practice Address - Country:US
Practice Address - Phone:252-752-1253
Practice Address - Fax:252-757-3058
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7700164Medicaid
NC04927OtherNC BCBS #
NC0202410001Medicare NSC