Healthcare Provider Details

I. General information

NPI: 1114925351
Provider Name (Legal Business Name): CHARLES J SCAGLIOTTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date: 03/16/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

1255 S CEDAR CREST BLVD STE 1100
ALLENTOWN PA
18103-6256
US

IV. Provider business mailing address

1255 S CEDAR CREST BLVD STE 1100
ALLENTOWN PA
18103-6256
US

V. Phone/Fax

Practice location:
  • Phone: 610-770-3270
  • Fax: 610-432-3249
Mailing address:
  • Phone: 610-770-3270
  • Fax: 610-432-3249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD032904L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: