Healthcare Provider Details

I. General information

NPI: 1164597993
Provider Name (Legal Business Name): LOUIS G. PETCU, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 HOSPITAL DR STE 103
HOLYOKE MA
01040-6603
US

IV. Provider business mailing address

785 WILLIAMS ST #354
LONGMEADOW MA
01106-2063
US

V. Phone/Fax

Practice location:
  • Phone: 413-538-8899
  • Fax: 413-538-7122
Mailing address:
  • Phone: 413-538-8899
  • Fax: 413-538-7122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number75221
License Number StateMA

VIII. Authorized Official

Name: DR. LOUIS GEORGE PETCU
Title or Position: PRESIDENT
Credential: M.D., M.S.
Phone: 413-538-8899