=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215918933
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PASQUALE PETRERA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2005
-----------------------------------------------------
Last Update Date | 08/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1675 WOODBROOKE DRIVE
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-749-4154
-----------------------------------------------------
Fax | 410-860-9583
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 69709
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21264-9709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-749-4154
-----------------------------------------------------
Fax | 410-860-9583
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XS0114X
-----------------------------------------------------
Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | D44707
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------