Healthcare Provider Details

I. General information

NPI: 1902871098
Provider Name (Legal Business Name): JOHN PELEGANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 CORBIN AVE
NEW BRITAIN CT
06053-2266
US

IV. Provider business mailing address

2150 CORBIN AVE
NEW BRITAIN CT
06053-2266
US

V. Phone/Fax

Practice location:
  • Phone: 860-827-4838
  • Fax: 860-832-6274
Mailing address:
  • Phone: 860-827-4838
  • Fax: 860-832-6274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number026351
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: