Healthcare Provider Details

I. General information

NPI: 1427222595
Provider Name (Legal Business Name): CHRISTIAN A PETRULIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300C FAUNCE CORNER RD
NORTH DARTMOUTH MA
02747-1257
US

IV. Provider business mailing address

200 MILL RD SUITE 180
FAIRHAVEN MA
02719-5252
US

V. Phone/Fax

Practice location:
  • Phone: 508-973-2230
  • Fax: 508-973-1195
Mailing address:
  • Phone: 508-973-2000
  • Fax: 508-973-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberMD15993
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number257685
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: