Healthcare Provider Details

I. General information

NPI: 1306091319
Provider Name (Legal Business Name): RICK F GAGLIANO CP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: FEDRICK R GAGLIANO CP

II. Dates (important events)

Enumeration Date: 11/19/2008
Last Update Date: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 WEST 5TH STREET CAROLINA ORTHO PROSTHETICS INC
GREENVILLE NC
27834-7812
US

IV. Provider business mailing address

PO BOX 5066 CAROLINA ORTHO PROSTHETICS INC
GREENVILLE NC
27835-5066
US

V. Phone/Fax

Practice location:
  • Phone: 252-752-1253
  • Fax: 252-757-3058
Mailing address:
  • Phone: 252-752-1253
  • Fax: 252-757-3058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: