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General NPI Number Information
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NPI Number | 1033344171
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Entity Type | Individual
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Provider Name | MARK PETROCELLI D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/19/2009
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Last Update Date | 01/22/2024
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Provider Practice Location Address
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Address Line | 9104 BABCOCK BLVD FL 5
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City | PITTSBURGH
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State | PA
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Zip | 15237-5866
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Country | US
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Telephone | 412-748-7444
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Fax |
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Provider Business Mailing Address
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Address Line | 9104 BABCOCK BLVD FL 5
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City | PITTSBURGH
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State | PA
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Zip | 15237-5866
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Country | US
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Telephone | 412-748-7444
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Fax |
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 5101018133
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | OS021275
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License Number State | PA
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