1730158999 NPI number — MARCELLO PIETRANTONI M.D.

Table of content: MARCELLO PIETRANTONI M.D. (NPI 1730158999)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730158999 NPI number — MARCELLO PIETRANTONI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PIETRANTONI
Provider First Name:
MARCELLO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730158999
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 E GRAY ST
Provider Second Line Business Mailing Address:
STE.602
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40202-3900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-582-6900
Provider Business Mailing Address Fax Number:
502-582-5400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 E GRAY ST
Provider Second Line Business Practice Location Address:
STE.602
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-3900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-582-6900
Provider Business Practice Location Address Fax Number:
502-582-5400
Provider Enumeration Date:
03/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  29075 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VM0101X , with the licence number: 29075 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 60011682 . This is a "MDWISE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 64290752 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4341270 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 810360 . This is a "MANAGED HEALTH SERVICES" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 50010517 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 100365180B , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com