Provider Demographics
NPI:1578545745
Name:PELLEGRINO, ANTHONY A (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:A
Last Name:PELLEGRINO
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 1:277 E MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-1207
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:277 E MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-1207
Practice Address - Country:US
Practice Address - Phone:508-852-2026
Practice Address - Fax:508-856-7130
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2014-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA50256207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3096882Medicaid
MA3096882Medicaid
MAA3556401Medicare PIN