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General NPI Number Information
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NPI Number | 1730411430
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Entity Type | Organization
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Legal Business Name | NICHOLAS G. BAGNOLI DO PA
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Dates
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Enumeration Date | 02/04/2010
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Last Update Date | 03/25/2010
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Provider Practice Location Address
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Address Line | 1220 SLIGH BLVD
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City | ORLANDO
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State | FL
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Zip | 32806-1108
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Country | US
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Telephone | 407-210-4251
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Fax | 407-648-0968
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Provider Business Mailing Address
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Address Line | 3869 WINDERLAKES DR
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City | ORLANDO
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State | FL
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Zip | 32835-2625
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Country | US
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Telephone | 407-210-4251
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Fax | 407-648-0968
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Authorized Official
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Title or Position | OWNER
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Name | DR. NICHOLAS G BAGNOLI
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Credential | MD
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Telephone | 407-210-4251
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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