Provider Demographics
NPI:1376536284
Name:PELLEGRINI, ARTHUR E (MD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:E
Last Name:PELLEGRINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 LONDON AVE
Mailing Address - Street 2:STE A
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040
Mailing Address - Country:US
Mailing Address - Phone:937-578-4206
Mailing Address - Fax:937-578-2740
Practice Address - Street 1:660 LONDON AVE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-1515
Practice Address - Country:US
Practice Address - Phone:937-578-4206
Practice Address - Fax:937-578-2740
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35055850P207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0723980Medicaid
OHPE0869699Medicare ID - Type Unspecified
OH0723980Medicaid