Individual
MARK J. PELLEGRINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6651 FRANK AVE NW, NORTH CANTON, OH 44720
(330) 498-9865
(330) 498-9869
Mailing address
PO BOX 26125, AKRON, OH 44319-6125
(330) 493-0840
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
35050212
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000141768
ANTHEM
OH
05
—
0715739
—
OH
01
—
250011247
RAILROAD MEDICARE
OH
01
—
341750133
SUMMACARE
OH
01
—
341898905030
CARESOURCE
OH
01
—
341898905B
AULTCARE
OH
Enumeration date
08/11/2006
Last updated
11/02/2016
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