=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114925351
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARLES J SCAGLIOTTI MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2005
-----------------------------------------------------
Last Update Date | 05/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1255 S CEDAR CREST BLVD STE 1100
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18103-6256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-770-3270
-----------------------------------------------------
Fax | 610-432-3249
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1255 S CEDAR CREST BLVD STE 1100
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18103-6256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-770-3270
-----------------------------------------------------
Fax | 610-432-3249
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | MD032904L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------