MEDICARE: DR. FLAVIUS F. GUGLIELMO MD

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	2085R0202X	Diagnostic Radiology Physician	MD037502E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346246642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FLAVIUS F. GUGLIELMO MD

Provider Business Mailing Address
First Line	:	111 S 11TH ST
Second Line	:	SUITE 3390
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4824
Country	:	US
Telephone Number	:	215-955-2900
Fax Number	:	215-923-1562

Provider Business Practice Location Address
First Line	:	111 S 11TH ST
Second Line	:	SUITE 3390
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4824
Country	:	US
Telephone Number	:	215-955-2900
Fax Number	:	215-923-1562

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	03/20/2015

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