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General NPI Number Information
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NPI Number | 1457310724
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Entity Type | Individual
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Provider Name | MARIO EMILIO PELLETIER M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 11/28/2025
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Provider Practice Location Address
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Address Line | 920 N JOHN YOUNG PKWY
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City | KISSIMMEE
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State | FL
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Zip | 34741-4914
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Country | US
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Telephone | 407-956-1920
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Fax | 833-450-5410
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Provider Business Mailing Address
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Address Line | 425 W COLONIAL DR STE 303
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City | ORLANDO
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State | FL
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Zip | 32804-6863
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Country | US
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Telephone | 407-956-1920
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Fax | 689-304-0303
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 42560
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME159611
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License Number State | FL
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