Basic Information
| Provider Information | |||||||||
| NPI: | 1962478891 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAGLIO | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.P.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 E GUDE DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208501341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019337133 | ||||||||
| FaxNumber: | 3019337137 | ||||||||
| Practice Location | |||||||||
| Address1: | 2050 ABBEY RD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229113540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4342954443 | ||||||||
| FaxNumber: | 4342958598 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2006 | ||||||||
| LastUpdateDate: | 11/27/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 0103300834 | VA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 009303081 | 05 | VA | MEDICAID | 1548333842 | 01 | VA | TYPE 2 NPI | OTHER |