Healthcare Provider Details

I. General information

NPI: 1114994233
Provider Name (Legal Business Name): KATHARINA PELLEGRIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHARINA PELLEGRIN-FLEMING

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date: 07/17/2007
Reactivation Date: 11/25/2008

III. Provider practice location address

900 HYDE ST
SAN FRANCISCO CA
94109-4806
US

IV. Provider business mailing address

4205 BELFORT RD STE 4015
JACKSONVILLE FL
32216-3623
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-6255
  • Fax: 850-913-6961
Mailing address:
  • Phone: 904-450-6014
  • Fax: 904-450-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberA63604
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number0101265079
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101265079
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number0101265079
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME141879
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: