Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | D44707 | MD |
NPI | 1215918933 |
---|---|
Provider Name | Dr. Pasquale Petrera |
First Address | Salisbury, MD 21802-2415 |
Second Address | Salisbury, MD 21804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 06/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000575601 | (05) | DE |
0008W409 | BCBS PROD FEP BLUE CHOICE (01) | |
006400248 | (05) | VA |
091051 | TRIGON BCBS (01) | VA |
200022316 | RAILROAD MEDICARE (01) | |
217742 | MDIPA OPTIMUM CHOICE (01) | MD |
221921800 | US DEPARTMENT OF LABOR (01) | |
3226879 | AETNA (01) | |
327279 | PRIME HEALTH (01) | |
44707 | FREESTATE DELMARVA HEALTH (01) | |
52819001H524PE | BCBS TRAD PRODUCTS (01) | |
588841700 | (05) | MD |
66G41 | EMPIRE BCBS (01) | |
F63265 | (02) | MD |