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NPI Code Detail

MEDICARE: HEATHER ANNETTE PETROLLA DPM

MEDICARE: HEATHER ANNETTE PETROLLA DPM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213E00000XPodiatrist36 00 1865 POH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1341581408 02OTHEROHIO BUREAU OF WORTHERS C
2000000134629OTHERANTHEM BLUE CROSS BLUE SH
3000000134628OTHERANTHEM BLUE CROSS BLUE SH
4341581408 01OTHEROHIO BUREAU OF WORTHERS C
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6000000134627OTHERANTHEM BLUE CROSS BLUE SH
727 00411OTHERUNITED HEALTHCARE
8341581408011OTHERMEDICAL MUTUAL
927 00142OTHERUNITED HEALTHCARE
10341581408009OTHERMEDICAL MUTUAL

General Provider Information

NPI Number : 1740272897
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER ANNETTE PETROLLA DPM
Provider Business Mailing Address
First Line : 3507 CANFIELD RD
Second Line : SUITE 7
City : YOUNGSTOWN
State : OH
Zip : 44511-2859
Country : US
Telephone Number : 330-793-0566
Fax Number : 330-793-5767
Provider Business Practice Location Address
First Line : 924 YOUNGSTOWN POLAND RD
Second Line :
City : STRUTHERS
State : OH
Zip : 44471-1305
Country : US
Telephone Number : 330-707-1360
Fax Number : 330-707-1359
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2005
Last Update Date : 03/06/2008

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Directions to “ HEATHER ANNETTE PETROLLA DPM” Practice Location

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