=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790355345
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RALPH MAGLIANO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2021
-----------------------------------------------------
Last Update Date | 06/27/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1075 OLD HARRISBURG RD
-----------------------------------------------------
City | GETTYSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17325-3135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-334-6204
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 COLET CIR
-----------------------------------------------------
City | BROOMALL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19008-2638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-761-2302
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SL015012
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------