Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 34006863 | OH |
NPI | 1003828849 |
---|---|
Provider Name | Joseph Jude Glorioso |
First Address | Saint Clairsville, OH 43950-8736 |
Second Address | Saint Clairsville, OH 43950-8736 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 21/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0055393000 | (05) | WV |
2077845 | (05) | OH |
G74430 | (02) | OH |
P00141754 | RAILROAD MEDICARE (01) |