Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD451111 | PA |
Y | 207XS0117X | Orthopaedic Spine Surgeon | MD451111 | PA |
NPI | 1194906065 |
---|---|
Provider Name | Dr. Carmen Anthony Petraglia |
First Address | Bethel Park, PA 15102-1827 |
Second Address | Bethel Park, PA 15102-1827 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2007 |
Last Update Date | 24/06/2014 |