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General NPI Number Information
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NPI Number | 1871545095
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Entity Type | Individual
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Provider Name | BRIAN M PETRONE PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 736 CAMBRIDGE ST
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City | BRIGHTON
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State | MA
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Zip | 02135-2907
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Country | US
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Telephone | 617-789-3000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 86
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City | HINGHAM
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State | MA
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Zip | 02043-0086
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Country | US
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Telephone | 781-749-9071
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Fax | 781-749-2133
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1833
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 1833
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License Number State | MA
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