Healthcare Provider Details

I. General information

NPI: 1952394140
Provider Name (Legal Business Name): RICHARD ALAN PELLEGRINI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 09/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST # HX307
LEXINGTON KY
40536-0293
US

IV. Provider business mailing address

800 ROSE ST # HX307
LEXINGTON KY
40536-0293
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5069
  • Fax: 859-257-4457
Mailing address:
  • Phone: 859-323-5069
  • Fax: 859-257-4457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number000035462
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number40306
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: