Provider Demographics
NPI:1609825215
Name:PELSTRING, RICHARD JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JOSEPH
Last Name:PELSTRING
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 1:3535 SOUTHERN BLVD.
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429
Mailing Address - Country:US
Mailing Address - Phone:937-395-8849
Mailing Address - Fax:937-395-8350
Practice Address - Street 1:3535 SOUTHERN BLVD.
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429
Practice Address - Country:US
Practice Address - Phone:937-395-8849
Practice Address - Fax:937-395-8350
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057897207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0914354Medicaid
OH7019001Medicare ID - Type Unspecified
OH0914354Medicaid
OHF20368Medicare UPIN