Healthcare Provider Details

I. General information

NPI: 1154389187
Provider Name (Legal Business Name): RICK ANTHONY PELLANT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LONDON MOUNTAIN VIEW DR FL 1
LONDON KY
40741-6668
US

IV. Provider business mailing address

PO BOX 21890
BELFAST ME
04915-4115
US

V. Phone/Fax

Practice location:
  • Phone: 859-275-5229
  • Fax:
Mailing address:
  • Phone: 502-907-0356
  • Fax: 502-919-9780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number03155
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: