Provider Demographics
NPI:1265417463
Name:GUAGLIARDO, JOSEPH P (DO)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:P
Last Name:GUAGLIARDO
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 1:4190 CITY AVE
Mailing Address - Street 2:SUITE 315
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-1626
Mailing Address - Country:US
Mailing Address - Phone:215-871-6942
Mailing Address - Fax:215-871-6943
Practice Address - Street 1:4190 CITY AVE
Practice Address - Street 2:SUITE 315
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-1626
Practice Address - Country:US
Practice Address - Phone:215-871-6942
Practice Address - Fax:215-871-6943
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003845L207XX0004X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA007003846Medicaid
PA007003846Medicaid
B18094Medicare UPIN