# NICHOLAS G. BAGNOLI DO PA

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** NICHOLAS G, BAGNOLI DO PA
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1730411430
- **Legal business name:** NICHOLAS G, BAGNOLI DO PA
- **Authorized official:** DR. NICHOLAS G BAGNOLI MD (OWNER)
- **Authorized official phone:** (407) 210-4251

## Contact information

- **Practice address:** 1220 SLIGH BLVD, ORLANDO, FL 32806-1108
- **Practice address phone:** (407) 210-4251
- **Practice address fax:** (407) 648-0968
- **Mailing address:** 3869 WINDERLAKES DR, ORLANDO, FL 32835-2625
- **Mailing address phone:** (407) 210-4251
- **Mailing address fax:** (407) 648-0968

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/04/2010
- **Last updated:** 03/25/2010