Provider Demographics
NPI:1306847348
Name:GLORIOSO, ROBERT CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CHARLES
Last Name:GLORIOSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:924 COLONIAL AVE STE M
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3450
Practice Address - Country:US
Practice Address - Phone:717-845-4846
Practice Address - Fax:717-845-5181
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027434E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009444800004Medicaid
PA1N2974OtherMEDICARE
PA10381OtherHEALTHAMERICA
PA080023293OtherRAILROAD MEDICARE
PA236710OtherMAMSI #
PA15485OtherGEISINGER #
PA173591OtherBLUE SHIELD ID #
PA01139401OtherBLUE CROSS INDIVIDUAL #
B33965Medicare UPIN
PA02443700OtherBLUE CROSS GROUP #
PA10381OtherHEALTHAMERICA