Provider Demographics
NPI:1063415099
Name:PELLEGRINI, ADRIAN J (MD)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:J
Last Name:PELLEGRINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4121 SHELBYVILLE RD STE 3
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3205
Mailing Address - Country:US
Mailing Address - Phone:502-899-9980
Mailing Address - Fax:502-899-9981
Practice Address - Street 1:4003 KRESGE WAY
Practice Address - Street 2:STE 224
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4652
Practice Address - Country:US
Practice Address - Phone:502-899-9980
Practice Address - Fax:502-899-9981
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY254302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64254303Medicaid
KYC76172Medicare UPIN
KY1467401Medicare ID - Type Unspecified