Healthcare Provider Details

I. General information

NPI: 1205821261
Provider Name (Legal Business Name): JOHN L. PELLEGRINI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 12/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 HOSPITAL RD SUITE 1
WHITESBURG KY
41858-7627
US

IV. Provider business mailing address

255 MAIN ST P.O. BOX 983
WHITESBURG KY
41858-7315
US

V. Phone/Fax

Practice location:
  • Phone: 606-633-2255
  • Fax: 606-633-3814
Mailing address:
  • Phone: 606-633-2261
  • Fax: 606-633-9643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number19935
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101035778
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: