Healthcare Provider Details

I. General information

NPI: 1447225719
Provider Name (Legal Business Name): NATALE JOSEPH GAGLIARDI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2528 MOUNTAIN RD #204
PASADENA MD
21122-2300
US

IV. Provider business mailing address

5101 PENFIELD RD W
COLUMBIA MD
21045-2218
US

V. Phone/Fax

Practice location:
  • Phone: 410-255-4475
  • Fax: 410-255-6277
Mailing address:
  • Phone: 410-707-7547
  • Fax: 410-992-6804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberD25774
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: