Provider Demographics
NPI:1104829902
Name:BRIGUGLIO, JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:BRIGUGLIO
Suffix:
Gender:M
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:PO BOX 4216
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17604-4216
Mailing Address - Country:US
Mailing Address - Phone:717-412-1295
Mailing Address - Fax:717-509-6362
Practice Address - Street 1:555 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2250
Practice Address - Country:US
Practice Address - Phone:717-394-6028
Practice Address - Fax:717-394-9223
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD063610L2085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA300115841OtherRAILROAD MEDICARE
PA01796256Medicaid
PA038398YYYOtherMEDICARE PTAN
PA231855378OtherTAX ID - LANC RADIOLOGY
PA01796256Medicaid
PA038398Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER