| Doctor Name: | MAUREEN MILLER PELLETIER |
| NPI Number: | 1043206956 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | 27524 |
| Business Practice Address: | 1 Medical Village Dr Edgewood, KY - 410173403 |
| Business Phone Number: | 8593012440 |
| Business Fax Number: | 8593012493 |
| Mailing Address: | 2300 Chamber Center Dr, Suite 200 LAKESIDE PARK |
| State: | KY |
| Postal Code: | 410171673 |
| Phone Number: | 8593445555 |
| Fax Number: | 8593445552 |
| NPI Enumeration Date: | 09/26/2005 |
| NPI Last Update Date: | 09/28/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 27524 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | KY |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |