Provider Demographics
NPI:1699791772
Name:GROGLIO, GREGORY LOUIS (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:LOUIS
Last Name:GROGLIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:857 BROWNSWITCH RD
Mailing Address - Street 2:SUITE 313
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-5335
Mailing Address - Country:US
Mailing Address - Phone:985-726-0026
Mailing Address - Fax:985-726-0024
Practice Address - Street 1:1051 GAUSE BLVD
Practice Address - Street 2:SUITE 370
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2951
Practice Address - Country:US
Practice Address - Phone:985-726-0026
Practice Address - Fax:985-726-0024
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08643R208G00000X
MS17361208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1972614Medicaid
MS17361OtherMEDICAL LICENSE