Provider Demographics
NPI:1114925351
Name:SCAGLIOTTI, CHARLES J (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:SCAGLIOTTI
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 1:1255 S CEDAR CREST BLVD
Mailing Address - Street 2:STE 1100
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6256
Mailing Address - Country:US
Mailing Address - Phone:610-770-3270
Mailing Address - Fax:610-432-3249
Practice Address - Street 1:1255 S CEDAR CREST BLVD
Practice Address - Street 2:STE 1100
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6256
Practice Address - Country:US
Practice Address - Phone:610-770-3270
Practice Address - Fax:610-432-3249
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2008-05-16
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
PAMD032904L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02356100OtherKEYSTONE HP CENTRAL
1077454OtherFIRST HEALTH
PA1808787OtherHIGHMARK BLUE SHIELD
PA0007587600007Medicaid
PA0679297000OtherAMERIHEALTH PPO & HMO
PA175720OtherUNISON AB
PA020042619OtherRAILROAD MEDICARE
1057378001OtherCIGNA
14339OtherGEISINGER HEALTH
PA4502785OtherAETNA USHC
01004101OtherCAPITAL BLUE CROSS
PA1106985OtherAMERIHEALTH/MERCY
000116466OtherHIGHMARK PPO
0010131800OtherBLACK LUNG
0040083000OtherINDEPENDENCE BLUE CROSS
PA2646498000OtherKEYSTONE HP EAST
PA0040083000OtherPERSONAL CHOICE
PA7116466OtherGATEWAY
116466F78Medicare PIN