Provider Demographics
NPI:1164756631
Name:PELTO, DONALD E (DPM)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:E
Last Name:PELTO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 LINCOLN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-3646
Mailing Address - Country:US
Mailing Address - Phone:508-757-4003
Mailing Address - Fax:508-755-7592
Practice Address - Street 1:299 LINCOLN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-3646
Practice Address - Country:US
Practice Address - Phone:508-757-4003
Practice Address - Fax:508-755-7592
Is Sole Proprietor?:No
Enumeration Date:2009-09-30
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2343213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist