Healthcare Provider Details

I. General information

NPI: 1871643650
Provider Name (Legal Business Name): FLYNN AND PETROSKY PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 05/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 BOGLE ST SUITE 104
SOMERSET KY
42503-2892
US

IV. Provider business mailing address

340 BOGLE ST SUITE 104
SOMERSET KY
42503-2892
US

V. Phone/Fax

Practice location:
  • Phone: 606-677-9250
  • Fax:
Mailing address:
  • Phone: 606-677-9250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUSAN J PETROSKY
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 606-677-9250