Provider Demographics
NPI:1578716361
Name:KENTUCKIANA PERINATOLOGY PSC
Entity Type:Organization
Organization Name:KENTUCKIANA PERINATOLOGY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCELLO
Authorized Official - Middle Name:
Authorized Official - Last Name:PIETRANTONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-582-6900
Mailing Address - Street 1:210 E GRAY ST STE 602
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3902
Mailing Address - Country:US
Mailing Address - Phone:502-582-6900
Mailing Address - Fax:
Practice Address - Street 1:210 E GRAY ST STE 602
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3902
Practice Address - Country:US
Practice Address - Phone:502-582-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENTUCKIANA PERINATOLOGY PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3321P363LP1700X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP1700XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPerinatalGroup - Single Specialty
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty