Provider Demographics
NPI:1043275001
Name:GAZIANO, PHILIP F (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:F
Last Name:GAZIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:354 BIRNIE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1109
Mailing Address - Country:US
Mailing Address - Phone:413-733-3470
Mailing Address - Fax:413-732-4216
Practice Address - Street 1:354 BIRNIE AVE STE 202
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1109
Practice Address - Country:US
Practice Address - Phone:413-733-3470
Practice Address - Fax:413-732-4216
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73206207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA97218844Medicaid
E60213Medicare UPIN
110183529Medicare PIN
MAJ10279Medicare ID - Type Unspecified