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General NPI Number Information
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NPI Number | 1033182662
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Entity Type | Individual
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Provider Name | WILLIAM R PETRICONE JR. MD
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Gender | Male
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Dates
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Enumeration Date | 02/13/2006
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Last Update Date | 10/29/2008
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Provider Practice Location Address
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Address Line | 1427 VINE ST SIXTH FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19102-1031
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Country | US
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Telephone | 215-762-6565
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Fax | 215-762-6997
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Provider Business Mailing Address
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Address Line | 1601 CHERRY ST SUITE 11511
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City | PHILADELPHIA
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State | PA
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Zip | 19102-1321
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Country | US
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Telephone | 215-255-7822
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Fax | 215-255-7825
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD434949
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | MD434948
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License Number State | PA
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