Provider Demographics
NPI:1154389187
Name:PELLANT, RICK ANTHONY (DO)
Entity type:Individual
Prefix:DR
First Name:RICK
Middle Name:ANTHONY
Last Name:PELLANT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21890
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4115
Mailing Address - Country:US
Mailing Address - Phone:502-907-0356
Mailing Address - Fax:502-919-9780
Practice Address - Street 1:100 LONDON MOUNTAIN VIEW DR FL 1
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-6668
Practice Address - Country:US
Practice Address - Phone:859-275-5229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY031552081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2970041OtherUNITED HEALTHCARE PROVIDER ID NUMBER
KY7100062440Medicaid
KY2064077OtherWELLCARE OF KY PROVIDER ID
KY133941KYIPOtherAETNA BETTER HEALTH OF KY PROVIDER ID
IN300031398Medicaid
000001313601OtherANTHEM PROVIDER ID
CS2005900276OtherCARESOURCE PROVIDER ID
KY00825001OtherMEDICARE