Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD018379E | PA |
N | 208600000X | Surgeon | MD018379E | PA |
Y | 2086S0129X | Vascular Surgeon | MD018379E | PA |
NPI | 1124011564 |
---|---|
Provider Name | Dr. Patrick Pellecchia |
First Address | Meaddowbrook, PA 19046 |
Second Address | Meaddowbrook, PA 19046 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2005 |
Last Update Date | 22/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0016178002 | (05) | PA |
001671780001 | (05) | PA |
B34171 | (02) | PA |