Provider Demographics
NPI:1730158999
Name:PIETRANTONI, MARCELLO (MD)
Entity type:Individual
Prefix:
First Name:MARCELLO
Middle Name:
Last Name:PIETRANTONI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E GRAY ST
Mailing Address - Street 2:STE.602
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3900
Mailing Address - Country:US
Mailing Address - Phone:502-582-6900
Mailing Address - Fax:502-582-5400
Practice Address - Street 1:210 E GRAY ST
Practice Address - Street 2:STE.602
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3900
Practice Address - Country:US
Practice Address - Phone:502-582-6900
Practice Address - Fax:502-582-5400
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29075207V00000X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN60011682OtherMDWISE
KY64290752Medicaid
4341270OtherAETNA
IN810360OtherMANAGED HEALTH SERVICES
KY50010517OtherPASSPORT
IN100365180BMedicaid
IN60011682OtherMDWISE
KY64290752Medicaid