Provider Demographics
NPI:1962402289
Name:GAGLIARDI, LISA GABRIELLE (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:GABRIELLE
Last Name:GAGLIARDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:220 ROBINHOOD LN
Mailing Address - Street 2:
Mailing Address - City:MCMURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2713
Mailing Address - Country:US
Mailing Address - Phone:724-941-8869
Mailing Address - Fax:
Practice Address - Street 1:2 HOT METAL ST
Practice Address - Street 2:ERMI QUANTUM ONE
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15203-2348
Practice Address - Country:US
Practice Address - Phone:412-432-7424
Practice Address - Fax:412-432-7789
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039973L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011429130010Medicaid
OH2268657Medicaid
WV3810010321Medicaid
PAP00432715Medicare PIN
OH2268657Medicaid
PADB7651Medicare PIN
PA536914NJRMedicare PIN