Provider Demographics
NPI:1629949391
Name:PELLERITI, RICHARD L
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:PELLERITI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 W KENWORTH RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-4036
Mailing Address - Country:US
Mailing Address - Phone:614-784-0403
Mailing Address - Fax:
Practice Address - Street 1:102 W KENWORTH RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-4036
Practice Address - Country:US
Practice Address - Phone:614-784-0403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No347C00000XTransportation ServicesPrivate Vehicle
No376J00000XNursing Service Related ProvidersHomemaker
No251X00000XAgenciesSupports Brokerage
No253Z00000XAgenciesIn Home Supportive Care