Provider Demographics
NPI:1649245176
Name:PELLEGRINI, DANIEL P (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:P
Last Name:PELLEGRINI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-2409
Mailing Address - Country:US
Mailing Address - Phone:510-220-9384
Mailing Address - Fax:
Practice Address - Street 1:302 4TH ST
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-2409
Practice Address - Country:US
Practice Address - Phone:510-220-9384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG88091174400000X
PAMD062510L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001659480Medicaid
PA957562FKYMedicare ID - Type Unspecified
PA001659480Medicaid