Healthcare Provider Details

I. General information

NPI: 1316305113
Provider Name (Legal Business Name): DANA PETRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2016
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6153 GOOD HUNTERS RIDE
COLUMBIA MD
21045-4068
US

IV. Provider business mailing address

6153 GOOD HUNTERS RIDE
COLUMBIA MD
21045-4068
US

V. Phone/Fax

Practice location:
  • Phone: 979-676-0368
  • Fax:
Mailing address:
  • Phone: 979-676-0368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number000000
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: