Individual
DR. SAMUEL V PELLEGRINO JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1350 HICKORY ST, MELBOURNE, FL 32901-3224
(321) 434-1401
(321) 434-1667
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
ME84614
FL
2086S0127X
Trauma Surgery Physician
Primary
ME84614
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2707055-00
—
FL
01
—
50172W
HFMG FL MEDICARE
FL
01
—
50172X
HFMG FL MEDICARE
FL
01
—
P01476869
FL RR MEDICARE
FL
Enumeration date
03/27/2006
Last updated
03/06/2020
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