Healthcare Provider Details

I. General information

NPI: 1871117382
Provider Name (Legal Business Name): GREGORY VINCENT GIGLIOTTI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL AVE
DU BOIS PA
15801-1440
US

IV. Provider business mailing address

5373 BIG RUN PRESCOTTVILLE RD
REYNOLDSVILLE PA
15851-8717
US

V. Phone/Fax

Practice location:
  • Phone: 814-371-2200
  • Fax:
Mailing address:
  • Phone: 814-619-1192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP022208
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN644247
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: