Provider Demographics
NPI:1063504512
Name:GUGLIELMO, MARIA A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:A
Last Name:GUGLIELMO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4336
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4336
Practice Address - Country:US
Practice Address - Phone:401-738-3730
Practice Address - Fax:401-738-3777
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11912207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9004550Medicaid
RIH09842Medicare UPIN