Provider Demographics
NPI:1295990182
Name:KRISTINE HERRMANN PELAGALLI MD INC
Entity type:Organization
Organization Name:KRISTINE HERRMANN PELAGALLI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-371-1287
Mailing Address - Street 1:1000 W WALLINGS RD STE C
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-1245
Mailing Address - Country:US
Mailing Address - Phone:440-717-2000
Mailing Address - Fax:440-717-2001
Practice Address - Street 1:1000 W WALLINGS RD STE C
Practice Address - Street 2:
Practice Address - City:BROADVIEW HTS
Practice Address - State:OH
Practice Address - Zip Code:44147-1245
Practice Address - Country:US
Practice Address - Phone:440-717-2000
Practice Address - Fax:440-717-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074513174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9324591Medicare PIN