Provider Demographics
NPI:1982697298
Name:PELLEGRINI, EDGARDO L (MD)
Entity Type:Individual
Prefix:
First Name:EDGARDO
Middle Name:L
Last Name:PELLEGRINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9193 SUNSET DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3487
Mailing Address - Country:US
Mailing Address - Phone:305-273-9377
Mailing Address - Fax:305-273-9388
Practice Address - Street 1:9193 SUNSET DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3487
Practice Address - Country:US
Practice Address - Phone:305-273-9377
Practice Address - Fax:305-273-9388
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0024881207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000280OtherNHP
FL058261100Medicaid
FL203923OtherAVMED
FL0395374OtherCIGNA
FL0395374OtherCIGNA
FL92155ZMedicare PIN
FLAP6452736OtherDEA