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General NPI Number Information
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NPI Number | 1306881198
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Entity Type | Individual
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Provider Name | LAWRENCE J PETROVICH M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 03/04/2008
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Provider Practice Location Address
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Address Line | 12 HOSPITAL DR SUITE 9
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City | YORK
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State | ME
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Zip | 03909-1030
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Country | US
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Telephone | 207-363-6136
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Fax | 207-363-4863
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Provider Business Mailing Address
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Address Line | 12 HOSPITAL DR SUITE 9
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City | YORK
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State | ME
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Zip | 03909-1030
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Country | US
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Telephone | 207-363-6136
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Fax | 207-363-4863
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 8487
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 6006
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License Number State | NH
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