Provider Demographics
NPI:1902843105
Name:PELLEGRINO, CHRISTOPHER J (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:J
Last Name:PELLEGRINO
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 1:314 W CARROLL ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5305
Mailing Address - Country:US
Mailing Address - Phone:410-546-0464
Mailing Address - Fax:410-546-8529
Practice Address - Street 1:314 W CARROLL ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5305
Practice Address - Country:US
Practice Address - Phone:410-546-0464
Practice Address - Fax:410-546-8529
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0043870208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD567LG530Medicare PIN
DE102280P29Medicare PIN
MDF88592Medicare UPIN