Provider Demographics
NPI:1952394140
Name:PELLEGRINI, RICHARD ALAN (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALAN
Last Name:PELLEGRINI
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 1:800 ROSE ST # HX307
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0293
Mailing Address - Country:US
Mailing Address - Phone:859-323-5069
Mailing Address - Fax:859-257-4457
Practice Address - Street 1:800 ROSE ST # HX307
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0293
Practice Address - Country:US
Practice Address - Phone:859-323-5069
Practice Address - Fax:859-257-4457
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0000354622085R0202X
KY403062085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8966713Medicaid
KY6412558600Medicaid
NC66713OtherBLUE CROSS BLUE SHIELD
NC8966713Medicaid
NC2172675Medicare ID - Type Unspecified
KY00980853Medicare PIN