Individual provider Active NPI

Dominic Francis Glorioso Jr., DO

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Harrisburg, PA
National Provider Identifier
1659309623
Registry record updated May 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospice and Palliative Medicine (Internal Medicine) PhysicianTaxonomy code 207RH0002X
License
OS005142L Issued in PA
Practice address
4310 Londonderry Rd
Suite 109
Harrisburg, PA 17109-5300
Phone
(717) 988-0611
Fax
(717) 231-8778
NPI assigned
Jun 29, 2006
Last updated
May 9, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X OS005142L PA
Hospitalist Physician 208M00000X OS005142L PA
Hospice and Palliative Medicine (Internal Medicine) Physician 207RH0002X OS005142L PA Primary

Addresses

Primary practice location

4310 Londonderry Rd
Suite 109
Harrisburg, PA 17109-5300

Mailing address

409 South Front St
Ste 2F
Harrisburg, PA 17104-1612
Phone (717) 988-0611

Other identifiers 1

IdentifierTypeStateIssuer
001664480MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050818000804 PA Practitioner - Hospice/Palliative CarePractitioner - Internal Medicine 5890725840 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OS005142LPAMDHospice and Palliative Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pinnacle Health Medical Services CurrentSince Oct 8, 2015 Accepting new patients
Pinnacle Health Medical Services CurrentSince Oct 8, 2015 Accepting new patients
Pinnacle Health Medical Services Internal Medicine Current Accepting new patients

Locations

205 S Front St
Harrisburg, PA 17104
Phone (717) 231-8360

2501 N 3rd St
Fl 2
Harrisburg, PA 17110
Phone (717) 782-2100

4310 Londonderry Rd
Ste 109
Harrisburg, PA 17109
Phone (717) 614-4420

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557360000000",
    "number": "1659309623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 SOUTH FRONT ST",
            "address_2": "STE 2F",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171041612",
            "telephone_number": "717-988-0611",
            "fax_number": "717-231-8778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4310 LONDONDERRY RD",
            "address_2": "SUITE 109",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171095300",
            "telephone_number": "717-988-0611",
            "fax_number": "717-231-8778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLORIOSO",
        "first_name": "DOMINIC",
        "middle_name": "FRANCIS",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-29",
        "last_updated": "2019-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "OS005142L",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "PA",
            "license": "OS005142L",
            "primary": false
        },
        {
            "code": "207RH0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": "PA",
            "license": "OS005142L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001664480",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Harrisburg, PA

Sources for this page

Verify at the official NPI Registry.