Provider Demographics
NPI:1114060506
Name:PELLEGRINO, MICHAEL A (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:PELLEGRINO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MELISSA ANN LN
Mailing Address - Street 2:
Mailing Address - City:MATTAPOISETT
Mailing Address - State:MA
Mailing Address - Zip Code:02739-1077
Mailing Address - Country:US
Mailing Address - Phone:508-679-3131
Mailing Address - Fax:
Practice Address - Street 1:CHARLTON MEMORIAL HOSP
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:00000
Practice Address - Country:US
Practice Address - Phone:508-679-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151013207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine