Provider Demographics
NPI:1124160346
Name:EDWARD W PELOTE MD PA
Entity type:Organization
Organization Name:EDWARD W PELOTE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MENDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARBOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-876-2179
Mailing Address - Street 1:1905 S 25TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-4739
Mailing Address - Country:US
Mailing Address - Phone:772-465-9901
Mailing Address - Fax:
Practice Address - Street 1:1905 S 25TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-4739
Practice Address - Country:US
Practice Address - Phone:772-465-9901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93493207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6768YMedicare PIN
FLU6768Medicare PIN
FLA97799Medicare UPIN
U6768YMedicare PIN
FLAB309Medicare PIN