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General NPI Number Information
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NPI Number | 1316371347
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Entity Type | Individual
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Provider Name | GLORIA T INTRIAGO M.D
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Gender | Female
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Dates
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Enumeration Date | 08/27/2013
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 9821 ACADEMY RD
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City | PHILADELPHIA
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State | PA
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Zip | 19114-1545
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Country | US
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Telephone | 215-632-8700
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Fax | 215-632-7865
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Provider Business Mailing Address
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Address Line | 1101 MARKET ST FL 19
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City | PHILADELPHIA
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State | PA
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Zip | 19107-2926
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Country | US
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Telephone | 215-481-6836
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | MD488788
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | P14559
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License Number State | NY
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