Provider Demographics
NPI:1699987321
Name:PATRICK PELLECCHIA
Entity type:Organization
Organization Name:PATRICK PELLECCHIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:PELLECCHIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-947-9272
Mailing Address - Street 1:1650 HUNTINGDON PIKE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MEADOWBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19046-8009
Mailing Address - Country:US
Mailing Address - Phone:215-947-9272
Mailing Address - Fax:215-947-6487
Practice Address - Street 1:1650 HUNTINGDON PIKE
Practice Address - Street 2:SUITE 350
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8009
Practice Address - Country:US
Practice Address - Phone:215-947-9272
Practice Address - Fax:215-947-6487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018379E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001671780001Medicaid
PA00161780002Medicaid
PA001671780001Medicaid
PA512086Medicare PIN