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General NPI Number Information
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NPI Number | 1861953002
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Entity Type | Individual
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Provider Name | ROBERT JERRY PETRILLO DO
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Gender | Male
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Dates
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Enumeration Date | 03/29/2019
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Last Update Date | 09/15/2024
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Provider Practice Location Address
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Address Line | 80 SEYMOUR ST
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City | HARTFORD
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State | CT
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Zip | 06106-3300
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Country | US
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Telephone | 860-545-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 100 RETREAT AVE STE 900
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City | HARTFORD
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State | CT
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Zip | 06106-2553
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Country | US
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Telephone | 860-218-2204
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 76176
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 1013106
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License Number State | MA
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