Provider Demographics
NPI:1639103955
Name:GUGLIELMO, THOMAS GERARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GERARD
Last Name:GUGLIELMO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 KENT RD
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-3485
Mailing Address - Country:US
Mailing Address - Phone:860-354-8616
Mailing Address - Fax:860-354-0473
Practice Address - Street 1:131 KENT RD
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-3485
Practice Address - Country:US
Practice Address - Phone:860-354-8616
Practice Address - Fax:860-354-0473
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00676213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT5925646OtherAETNA
CTOV8143OtherHEALTHNET
CT030000676CT05OtherISSUER
CT1006720OtherUS HEALTHCARE
CTP2181784OtherOXFORD
CT750988OtherCONNECTICARE
CT4926790-012OtherCIGNA
CTPC1351OtherEMPIRE
CTOV8143OtherHEALTHNET
CTU59280Medicare UPIN
CT4267730001Medicare NSC