MEDICARE: EDGARDO L 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	207RN0300X	Nephrology Physician	ME0024881	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000280	OTHER	FL	NHP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	203923	OTHER	FL	AVMED
4	0395374	OTHER	FL	CIGNA

General Provider Information

NPI Number	:	1982697298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDGARDO L PELLEGRINI MD

Provider Business Mailing Address
First Line	:	9193 SUNSET DR
Second Line	:	SUITE 200
City	:	MIAMI
State	:	FL
Zip	:	33173-3487
Country	:	US
Telephone Number	:	305-273-9377
Fax Number	:	305-273-9388

Provider Business Practice Location Address
First Line	:	9193 SUNSET DR
Second Line	:	SUITE 200
City	:	MIAMI
State	:	FL
Zip	:	33173-3487
Country	:	US
Telephone Number	:	305-273-9377
Fax Number	:	305-273-9388

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

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	03/07/2023

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