Healthcare Provider Details

I. General information

NPI: 1629058201
Provider Name (Legal Business Name): NICHOLAS J PETRELLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 OGLETOWN STANTON RD SUITE 1213
NEWARK DE
19713-2055
US

IV. Provider business mailing address

PO BOX 30170
WILMINGTON DE
19805-7170
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-4550
  • Fax: 302-623-4554
Mailing address:
  • Phone: 302-623-7362
  • Fax: 302-623-7374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberC1-0006443
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: