Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | SC003280L | PA |
NPI | 1093755936 |
---|---|
Provider Name | Dr. Edward J. Pellecchia |
First Address | Meadowbrook, PA 19046-8004 |
Second Address | Meadowbrook, PA 19046-8004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 08/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0004114916 | AETNA (01) | PA |
0012055400004 | (05) | PA |
0413304000 | INDEPENDENCE BLUE CROSS (01) | PA |
U20625 | (02) |