Provider Demographics
NPI:1033340823
Name:SCAGLIOLA, JENNIFER MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARIE
Last Name:SCAGLIOLA
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Gender:F
Credentials:DO
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Mailing Address - Street 1:117 E CLARK ST
Mailing Address - Street 2:SIH MEDICAL GROUP PRIMARY CARE HARRISBURG
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946-2702
Mailing Address - Country:US
Mailing Address - Phone:618-252-8625
Mailing Address - Fax:618-252-2540
Practice Address - Street 1:117 E CLARK ST
Practice Address - Street 2:SIH MEDICAL GROUP PRIMARY CARE HARRISBURG
Practice Address - City:HARRISBURG
Practice Address - State:IL
Practice Address - Zip Code:62946-2702
Practice Address - Country:US
Practice Address - Phone:618-252-8625
Practice Address - Fax:618-252-2540
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2016-01-11
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Provider Licenses
StateLicense IDTaxonomies
IL036139550208600000X
SCTL36714208600000X
NY275812208600000X
NC2015-02018208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery