Basic Information
| Provider Information | |||||||||
| NPI: | 1083290084 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PELLEGRINI | ||||||||
| FirstName: | WILLIAM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 830 HARRISON AVE STE 1400 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176387066 | ||||||||
| FaxNumber: | 6176387965 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 HARRISON AVE | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176387066 | ||||||||
| FaxNumber: | 6176387965 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2021 | ||||||||
| LastUpdateDate: | 07/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Y00000X | 289672 | MA | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.