Provider Demographics
NPI:1376239590
Name:GOLDSBORO CTC
Entity Type:Organization
Organization Name:GOLDSBORO CTC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GAGLIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-583-9329
Mailing Address - Street 1:1510 ROSE ST
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-3938
Mailing Address - Country:US
Mailing Address - Phone:919-394-2093
Mailing Address - Fax:
Practice Address - Street 1:1700 E ASH ST STE 201
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-4097
Practice Address - Country:US
Practice Address - Phone:919-583-9329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SI0800XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistInformaticsGroup - Single Specialty