Provider Demographics
NPI:1659402485
Name:PELUSO, WARREN MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:MARK
Last Name:PELUSO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PARTON HC
Mailing Address - Street 2:MIDDLEBURY COLLEGE 5110
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753
Mailing Address - Country:US
Mailing Address - Phone:804-443-5135
Mailing Address - Fax:802-443-2066
Practice Address - Street 1:PARTON HC
Practice Address - Street 2:MIDDLEBURY COLLEGE 5110
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753
Practice Address - Country:US
Practice Address - Phone:804-443-5135
Practice Address - Fax:802-443-2066
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT042-0010097207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT042-0010097OtherSTATE MEDICAL LICENSE
VTG92806Medicare UPIN