Provider Demographics
NPI:1790844223
Name:PELLETIER, HILARY (DPM)
Entity Type:Individual
Prefix:
First Name:HILARY
Middle Name:
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 BARIBEAU DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-3249
Mailing Address - Country:US
Mailing Address - Phone:207-729-6686
Mailing Address - Fax:207-729-6687
Practice Address - Street 1:85 BARIBEAU DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3249
Practice Address - Country:US
Practice Address - Phone:207-729-6686
Practice Address - Fax:207-729-6687
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD1024213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME039325OtherANTHEM
ME201190099Medicaid
ME2423714OtherAETNA
MEM174138OtherCIGNA
MEU71966OtherHARVARD PILGRIM HEALTHCAR
MEM174138OtherCIGNA
ME201190099Medicaid
ME2423714OtherAETNA