Provider Demographics
NPI:1508826819
Name:PELKOWSKI, DAVID J (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:PELKOWSKI
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 1:601 ELMWOOD AVE BOX 679-B
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-1707
Mailing Address - Fax:585-596-0135
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642
Practice Address - Country:US
Practice Address - Phone:585-275-2475
Practice Address - Fax:585-473-0477
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175364207RC0000X
NY175364-1207RC0000X
PAMD032222E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01086442Medicaid
PA060060326OtherRR MEDICARE PIN
VT1016353Medicaid
NY01086442Medicaid
NH001162901OtherMEDICARE B
PACC9269OtherRR MEDICARE GROUP
NYCC8362OtherRR MEDICARE GROUP
PAGU039823OtherPA MEDICARE GROUP
NH30208636Medicaid
NYP00324450OtherRR MEDICARE PIN
NH30208636Medicaid
NH001162901OtherMEDICARE B
PA060060326OtherRR MEDICARE PIN