Provider Demographics
NPI:1417138140
Name:GAGLIANO, ALLENE (MD)
Entity Type:Individual
Prefix:
First Name:ALLENE
Middle Name:
Last Name:GAGLIANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 FAWN DR
Mailing Address - Street 2:
Mailing Address - City:QUARRYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17566-9741
Mailing Address - Country:US
Mailing Address - Phone:717-284-3137
Mailing Address - Fax:717-284-4164
Practice Address - Street 1:34 FAWN DR
Practice Address - Street 2:
Practice Address - City:QUARRYVILLE
Practice Address - State:PA
Practice Address - Zip Code:17566-9741
Practice Address - Country:US
Practice Address - Phone:717-284-3137
Practice Address - Fax:717-284-4164
Is Sole Proprietor?:No
Enumeration Date:2007-11-22
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101243056207Q00000X
PAMD457627207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAMC12057Medicare UPIN