Provider Demographics
NPI:1962478891
Name:BAGLIO, ROBERT J (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:BAGLIO
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 1:1600 E GUDE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-1341
Mailing Address - Country:US
Mailing Address - Phone:301-933-7133
Mailing Address - Fax:301-933-7137
Practice Address - Street 1:2050 ABBEY RD
Practice Address - Street 2:SUITE C
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-3540
Practice Address - Country:US
Practice Address - Phone:434-295-4443
Practice Address - Fax:434-295-8598
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300834213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009303081Medicaid
VA1548333842OtherTYPE 2 NPI
VA0560720001Medicare NSC
VA480000699Medicare PIN
VA1548333842OtherTYPE 2 NPI
VAU84793Medicare UPIN
VA009303081Medicaid
VA1134365786Medicare PIN
VA0560720003Medicare NSC
VA1164668380Medicare PIN