Provider Demographics
NPI:1386641280
Name:BAGNARELLO, ADOLFO G (MD)
Entity Type:Individual
Prefix:DR
First Name:ADOLFO
Middle Name:G
Last Name:BAGNARELLO
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 1:176 GLADE MILL RD
Mailing Address - Street 2:
Mailing Address - City:SAXONBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16056-9764
Mailing Address - Country:US
Mailing Address - Phone:724-496-2699
Mailing Address - Fax:
Practice Address - Street 1:176 GLADE MILL RD
Practice Address - Street 2:
Practice Address - City:SAXONBURG
Practice Address - State:PA
Practice Address - Zip Code:16056-9764
Practice Address - Country:US
Practice Address - Phone:724-496-2699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2847A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY116941600Medicaid
WY110231850Medicare ID - Type UnspecifiedRR MEDICARE
WY116941600Medicaid
WYW301123Medicare ID - Type UnspecifiedMEDICARE NUMBER