Individual
JOANMARIE DIETZ PELLEGRINI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
360 BROADWAY, BANGOR, ME 04401-3979
(207) 907-3650
(207) 907-3660
Mailing address
C/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT, PO BOX 7291, LEWISTON, ME 04243-7291
(207) 777-8560
(207) 777-8800
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036-138577
IL
208600000X
Surgery Physician
81948
MA
2086S0127X
Trauma Surgery Physician
015414
ME
2086S0127X
Trauma Surgery Physician
81948
MA
2086S0127X
Trauma Surgery Physician
Primary
MD15414
ME
Other
Enumeration date
01/24/2006
Last updated
02/03/2022
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