MEDICARE: BARRY RICHARD SAGALOW M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085B0100X	Body Imaging Physician	MD028612E	PA
2	2085B0100X	Body Imaging Physician	25MA04647600	NJ
3	2085R0202X	Diagnostic Radiology Physician	MD028612E	PA
4	2085R0202X	Diagnostic Radiology Physician	25MA04647600	NJ
5	2085R0204X	Vascular & Interventional Radiology Physician	MD028612E	PA
6	2085R0204X	Vascular & Interventional Radiology Physician	25MA04647600	NJ

General Provider Information

NPI Number	:	1336119262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARRY RICHARD SAGALOW M.D.

Provider Business Mailing Address
First Line	:	PO BOX 782743
Second Line	:	ATTN: CREDENTIALING
City	:	PHILADELPHIA
State	:	PA
Zip	:	19178-2743
Country	:	US
Telephone Number	:	602-910-6887
Fax Number	:	215-612-5077

Provider Business Practice Location Address
First Line	:	5800 RIDGE AVE
Second Line	:	ATTN: RADIOLOGY
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-1737
Country	:	US
Telephone Number	:	215-612-2610
Fax Number	:	215-612-5077

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	01/20/2016

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