Provider Demographics
NPI:1992919898
Name:GAGLIARDI, GREGG STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:GREGG
Middle Name:STEPHEN
Last Name:GAGLIARDI
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 1:201 S 25TH ST
Mailing Address - Street 2:APT 523
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6002
Mailing Address - Country:US
Mailing Address - Phone:215-735-0102
Mailing Address - Fax:
Practice Address - Street 1:1095 RYDAL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-1711
Practice Address - Country:US
Practice Address - Phone:267-620-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD431271207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology