Provider Demographics
NPI:1770538258
Name:PELLETIER, RONALD P (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:P
Last Name:PELLETIER
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 1:10 PLUM ST FL 7
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-2066
Mailing Address - Country:US
Mailing Address - Phone:732-253-3360
Mailing Address - Fax:732-253-3476
Practice Address - Street 1:10 PLUM ST FL 7
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2066
Practice Address - Country:US
Practice Address - Phone:732-253-3360
Practice Address - Fax:732-253-3476
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10296500208600000X, 204F00000X
OH35058355204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0249645Medicaid
OH0249645Medicaid
G26976Medicare UPIN