Provider Demographics
NPI:1316371347
Name:INTRIAGO, GLORIA T (MD)
Entity type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:T
Last Name:INTRIAGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 MARKET ST FL 19
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-2926
Mailing Address - Country:US
Mailing Address - Phone:215-481-6836
Mailing Address - Fax:
Practice Address - Street 1:9821 ACADEMY RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1545
Practice Address - Country:US
Practice Address - Phone:215-632-8700
Practice Address - Fax:215-632-7865
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD488788208D00000X
NYP14559208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice