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General NPI Number Information
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NPI Number | 1669101010
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Entity Type | Individual
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Provider Name | TALIA ZOE GLODJO MD
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Gender | Female
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Dates
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Enumeration Date | 06/09/2022
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 3500 N BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19140-4106
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Country | US
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Telephone | 800-836-7536
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Fax |
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Provider Business Mailing Address
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Address Line | 4515 BAKER ST APT 1
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City | PHILADELPHIA
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State | PA
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Zip | 19127-1231
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Country | US
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Telephone | 919-641-2433
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MT226625
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License Number State | PA
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