Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | MD418247 | PA |
NPI | 1295790558 |
---|---|
Provider Name | Dr. Ronald D. Petrocelli |
First Address | Danville, PA 17822-3034 |
Second Address | Danville, PA 17822-2007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B66381 | (02) |