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General NPI Number Information
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NPI Number | 1912428202
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Entity Type | Individual
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Provider Name | BRAD PETITTI PA
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Gender | Male
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Dates
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Enumeration Date | 06/28/2017
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Last Update Date | 06/28/2017
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Provider Practice Location Address
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Address Line | 61 POMEROY AVE
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City | MERIDEN
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State | CT
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Zip | 06450-7482
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Country | US
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Telephone | 203-694-5350
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Fax |
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Provider Business Mailing Address
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Address Line | 437 W RUTLAND RD
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City | MILFORD
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State | CT
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Zip | 06461-2449
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3852
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License Number State | CT
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