Organization
FAIRFIELD FAMILY PRACTICE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN A PELLEGRINO DO (PHYSICIAN)
(570) 368-2002
Entity
Organization
Contact information
Practice address
1300 SHERIDAN STREET, SUITE 1, WILLIAMSPORT, PA 17701
(570) 601-6202
(570) 368-2064
Mailing address
1300 SHERIDAN STREET, SUITE 1, WILLIAMSPORT, PA 17701
(570) 601-6202
(570) 368-2064
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DS008076L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0075301990002
—
PA
Enumeration date
09/21/2006
Last updated
08/22/2020
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