Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 036-138577 | IL |
N | 208600000X | Surgeon | 036-138577 | IL |
N | 208200000X | Surgeon | 81948 | MA |
N | 208600000X | Surgeon | 81948 | MA |
N | 2086S0127X | Trauma Surgeon | 015414 | ME |
N | 2086S0127X | Trauma Surgeon | 81948 | MA |
Y | 2086S0127X | Trauma Surgeon | MD15414 | ME |
NPI | 1265402242 |
---|---|
Provider Name | Joanmarie Dietz Pellegrini |
First Address | Lewiston, ME 04243-7291 |
Second Address | Bangor, ME 04401-3979 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 03/02/2022 |