Provider Demographics
NPI:1508844192
Name:PELLOT, NORBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:NORBERTO
Middle Name:
Last Name:PELLOT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NORBERTO
Other - Middle Name:
Other - Last Name:PELLOT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:URB VALPARAISO CALLE 9 E-7 LEVITTOWN
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-4038
Mailing Address - Country:US
Mailing Address - Phone:787-740-8090
Mailing Address - Fax:787-786-5216
Practice Address - Street 1:GALLARDO TOWERS
Practice Address - Street 2:SUITE 206 CARRETERA # 2
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960
Practice Address - Country:US
Practice Address - Phone:787-740-8090
Practice Address - Fax:787-786-5216
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6308174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR27900Medicare ID - Type Unspecified