Provider Demographics
NPI:1548648421
Name:PELLAND, KEVIN TIMOTHY JR (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:TIMOTHY
Last Name:PELLAND
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:71 HAYNES STREET
Mailing Address - Street 2:PATHOLOGY DEPT
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040
Mailing Address - Country:US
Mailing Address - Phone:860-647-6487
Mailing Address - Fax:
Practice Address - Street 1:71 HAYNES STREET
Practice Address - Street 2:PATHOLOGY DEPT
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040
Practice Address - Country:US
Practice Address - Phone:606-647-6487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT65253207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty