Provider Demographics
NPI:1700833126
Name:PELLIGRA, SALVATORE JOHN (MD)
Entity Type:Individual
Prefix:
First Name:SALVATORE
Middle Name:JOHN
Last Name:PELLIGRA
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 1:2718 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-3633
Mailing Address - Country:US
Mailing Address - Phone:336-375-1007
Mailing Address - Fax:336-375-9615
Practice Address - Street 1:2718 HENRY ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-3633
Practice Address - Country:US
Practice Address - Phone:336-375-1007
Practice Address - Fax:336-375-9615
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28300208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7966723Medicaid
NC66723OtherBCBSNC
NC209500AMedicare PIN
NC7966723Medicaid