Provider Demographics
NPI:1275588899
Name:PAGLIARULO, ANTHONY R (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:R
Last Name:PAGLIARULO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:R
Other - Last Name:PAGLIARULO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:DEPT 252
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-729-2708
Mailing Address - Fax:901-729-2720
Practice Address - Street 1:333 S BELLEVUE BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3534
Practice Address - Country:US
Practice Address - Phone:901-729-2708
Practice Address - Fax:901-729-2720
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000024299207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3074170Medicaid
MS00111789Medicaid
AR124822001Medicaid
AR124822001Medicaid
TNF54059Medicare UPIN
TN3074170Medicaid