Healthcare Provider Details

I. General information

NPI: 1225177975
Provider Name (Legal Business Name): JOHN PETRASKY M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 JACKSON ST
FREDERICKSBURG VA
22401-5719
US

IV. Provider business mailing address

608 JACKSON ST
FREDERICKSBURG VA
22401-5719
US

V. Phone/Fax

Practice location:
  • Phone: 540-899-4797
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberJP049321
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number0101245896
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: