Provider Demographics
NPI:1659309623
Name:GLORIOSO, DOMINIC FRANCIS JR (DO)
Entity type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:FRANCIS
Last Name:GLORIOSO
Suffix:JR
Gender:M
Credentials:DO
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Mailing Address - Street 1:409 SOUTH FRONT ST
Mailing Address - Street 2:STE 2F
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:717-988-0611
Mailing Address - Fax:717-231-8778
Practice Address - Street 1:4310 LONDONDERRY RD
Practice Address - Street 2:SUITE 109
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5300
Practice Address - Country:US
Practice Address - Phone:717-988-0611
Practice Address - Fax:717-231-8778
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2019-05-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS005142L207R00000X, 208M00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001664480Medicaid
PA448950Medicare PIN
D27401Medicare UPIN
PA110153292Medicare PIN
PA580973OtherHIGHMARK BLUE SHIELD
PA20055976OtherAH MERCY-WMG YK PALL CARE
PA20090403OtherAMERIHEALTH MERCY-WMG HOSP
PA81507OtherUNISON-WMG DIM
PA1551849OtherGATEWAY-WMG YPC
D27401Medicare UPIN
PA50059455OtherCAPITAL BC-WMG BIMH
PA42407OtherGEISINGER
MD546801OtherCAREFIRST MD BCBS
PA1551849OtherGATEWAY-WMG BIMH
PA183811OtherUNISON-WMG BIMH
PAP002879OtherGATEWAY-WMG DIM/BIM
PA189942OtherUNISON-WMG YORK PALL CARE
PA50062337OtherCAPITAL BC-WMG PALL CARE
PA30090403OtherAMERIHEALTH MERCY - WMG
PA5666639OtherAETNA
PA580973FLTMedicare PIN