Provider Demographics
NPI:1467507384
Name:QUAGLIERI, CHARLES E (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:QUAGLIERI
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 1:330 E LIBERTY ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89501-2260
Mailing Address - Country:US
Mailing Address - Phone:775-398-3602
Mailing Address - Fax:775-398-3688
Practice Address - Street 1:330 E LIBERTY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-2260
Practice Address - Country:US
Practice Address - Phone:775-398-3602
Practice Address - Fax:775-398-3688
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV34442084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVVWCGZLMedicare ID - Type Unspecified
NVC96471Medicare UPIN
NV002016040Medicaid