Provider Demographics
NPI:1518920552
Name:GIGLIOTTI, DAVID T (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:T
Last Name:GIGLIOTTI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 ROUTE 73 N BLDG 10, SUITE 320
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053
Mailing Address - Country:US
Mailing Address - Phone:856-872-7055
Mailing Address - Fax:
Practice Address - Street 1:181 W WHITE HORSE PIKE STE 100
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-2032
Practice Address - Country:US
Practice Address - Phone:856-767-6044
Practice Address - Fax:856-767-3518
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06286100207QA0401X, 207Q00000X
MD2014416207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8014906Medicaid
P00447480OtherRAIL ROAD MEDICARE
077356 SK3Medicare PIN
P00447480OtherRAIL ROAD MEDICARE
018948Medicare PIN