Healthcare Provider Details

I. General information

NPI: 1407857246
Provider Name (Legal Business Name): JOSEPH EDWARD PELLEGRINI CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

10426 POPKINS CT
WOODSTOCK MD
21163-1316
US

V. Phone/Fax

Practice location:
  • Phone: 301-319-8080
  • Fax: 301-295-0827
Mailing address:
  • Phone: 410-750-3177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR152123
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: