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General NPI Number Information
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NPI Number | 1083769111
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Entity Type | Individual
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Provider Name | ANTHONY MICHAEL PELLEGRINO PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 11/14/2022
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Provider Practice Location Address
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Address Line | 271 CAREW ST
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City | SPRINGFIELD
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State | MA
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Zip | 01104-2377
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Country | US
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Telephone | 413-748-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 47 ALLEN RD DEPT OF
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City | LONGMEADOW
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State | MA
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Zip | 01106-1322
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Country | US
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Telephone | 508-633-2466
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0661
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | AP2303
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License Number State | MA
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