Provider Demographics
NPI:1639118755
Name:PALLADINO, DARRELL A (MD)
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:A
Last Name:PALLADINO
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 1:4216 KITANO CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-6335
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 TRILLIUM WAY
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-8426
Practice Address - Country:US
Practice Address - Phone:606-528-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29077207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64290778Medicaid
KY000000729956OtherANTHEM/TROVER CLINIC FOUNDATION INC
KYP00977282OtherRR MEDICARE
KY000000334211OtherBLUE CROSS BLUE SHIELD
KY000000729956OtherANTHEM/TROVER CLINIC FOUNDATION INC
KYK011090Medicare PIN
F67435Medicare UPIN
KY0954339Medicare ID - Type Unspecified