MEDICARE: THOMAS VICTOR PETROS PH.D.

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
1	103T00000X	Psychologist		ND

General Provider Information

NPI Number	:	1871679910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS VICTOR PETROS PH.D.

Provider Business Mailing Address
First Line	:	501 N COLUMBIA RD STOP 7132
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58203-2817
Country	:	US
Telephone Number	:	701-777-3745
Fax Number	:	701-777-3845

Provider Business Practice Location Address
First Line	:	501 N COLUMBIA RD STOP 7132
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58203-2817
Country	:	US
Telephone Number	:	701-777-3745
Fax Number	:	701-777-3845

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	02/15/2023

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