Healthcare Provider Details

I. General information

NPI: 1215918933
Provider Name (Legal Business Name): PASQUALE PETRERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 WOODBROOKE DRIVE
SALISBURY MD
21804
US

IV. Provider business mailing address

PO BOX 69709
BALTIMORE MD
21264-9709
US

V. Phone/Fax

Practice location:
  • Phone: 410-749-4154
  • Fax: 410-860-9583
Mailing address:
  • Phone: 410-749-4154
  • Fax: 410-860-9583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberD44707
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: