MEDICARE: DR. DANIEL P. PELLEGRINI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	W1873	TX
2	174400000X	Specialist	MD062510L	PA
3	174400000X	Specialist	G88091	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649245176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL P. PELLEGRINI MD

Provider Business Mailing Address
First Line	:	200 W MAGNOLIA AVE STE 201
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-7657
Country	:	US
Telephone Number	:	817-702-2977
Fax Number	:	817-702-2140

Provider Business Practice Location Address
First Line	:	302 4TH ST
Second Line	:
City	:	SAUSALITO
State	:	CA
Zip	:	94965-2409
Country	:	US
Telephone Number	:	510-220-9384
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2006
Last Update Date	:	02/18/2026

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