Provider Demographics
NPI:1497894950
Name:ARTHUR E. PELLEGRINI, M.D. LLC
Entity Type:Organization
Organization Name:ARTHUR E. PELLEGRINI, M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-642-1550
Mailing Address - Street 1:660 LONDON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-1515
Mailing Address - Country:US
Mailing Address - Phone:937-642-1550
Mailing Address - Fax:937-578-2821
Practice Address - Street 1:660 LONDON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-1515
Practice Address - Country:US
Practice Address - Phone:937-642-1550
Practice Address - Fax:937-578-2821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-055850207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0723980Medicaid
OH0723980Medicaid
OHA17465Medicare UPIN