Basic Information
| Provider Information | |||||||||
| NPI: | 1235180456 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TONY R PAGLIARULO MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1000 | ||||||||
| Address2: | DEPT 252 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381480001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017292708 | ||||||||
| FaxNumber: | 9017292720 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 S BELLEVUE BLVD | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381043534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017292708 | ||||||||
| FaxNumber: | 9017292720 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 07/09/2008 | ||||||||
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| AuthorizedOfficialLastName: | PAGLIARULO | ||||||||
| AuthorizedOfficialFirstName: | TONY | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9017292708 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD0000024299 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00111789 | 05 | MS | MEDICAID | 3074170 | 05 | TN | MEDICAID | 124822001 | 05 | AR | MEDICAID |