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General NPI Number Information
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NPI Number | 1124322185
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Entity Type | Organization
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Legal Business Name | WILLIAM D PETOK, PHD, PA
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Dates
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Enumeration Date | 01/06/2011
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Last Update Date | 01/06/2011
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Provider Practice Location Address
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Address Line | 479 JUMPERS HOLE RD SUITE 304B
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City | SEVERNA PARK
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State | MD
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Zip | 21146-1600
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Country | US
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Telephone | 410-647-9166
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Fax | 410-647-9174
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Provider Business Mailing Address
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Address Line | 479 JUMPERS HOLE RD SUITE 304B
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City | SEVERNA PARK
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State | MD
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Zip | 21146-1600
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Country | US
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Telephone | 410-647-9166
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Fax | 410-647-9174
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM DAVID PETOK
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Credential | PHD
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Telephone | 410-647-9166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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