Provider Demographics
NPI:1346320231
Name:PELLEGRINI, LAWRENCE J (DO)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:J
Last Name:PELLEGRINI
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 1:3196 S MARYLAND PKWY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2305
Mailing Address - Country:US
Mailing Address - Phone:702-893-3833
Mailing Address - Fax:702-893-4736
Practice Address - Street 1:3186 S MARYLAND PKWY
Practice Address - Street 2:DEPARTMENT OF EMERGENCY SERVICES
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2317
Practice Address - Country:US
Practice Address - Phone:702-893-3833
Practice Address - Fax:702-893-4736
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV741207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2019800Medicaid
NVEG509YMedicare PIN
NVEG509ZMedicare PIN
NV2019800Medicaid
NVWQBGM16Medicare ID - Type UnspecifiedMEDICARE ID NUMBER