Provider Demographics
NPI:1518296102
Name:DIGLIO, PHILIP ANDREW (LO)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:ANDREW
Last Name:DIGLIO
Suffix:
Gender:M
Credentials:LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 UNIVERSAL DR N
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-3143
Mailing Address - Country:US
Mailing Address - Phone:203-239-0111
Mailing Address - Fax:203-239-5556
Practice Address - Street 1:212 UNIVERSAL DR N
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-3143
Practice Address - Country:US
Practice Address - Phone:203-239-0111
Practice Address - Fax:203-239-5556
Is Sole Proprietor?:No
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT697156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
1311140001Medicare PIN
CT1311140001Medicare PIN