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NPI Code Detail

MEDICARE: KIMBERLY A PETRUSO DO

MEDICARE: KIMBERLY A PETRUSO DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianOS009953LPA

General Provider Information

NPI Number : 1043285703
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY A PETRUSO DO
Provider Business Mailing Address
First Line : 1601 MEDICAL DR
Second Line :
City : POTTSTOWN
State : PA
Zip : 19464-3241
Country : US
Telephone Number : 610-327-4200
Fax Number : 610-327-8160
Provider Business Practice Location Address
First Line : 23 N WALNUT ST
Second Line :
City : BOYERTOWN
State : PA
Zip : 19512-1467
Country : US
Telephone Number : 610-367-2259
Fax Number : 610-367-0505
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2006
Last Update Date : 12/17/2019

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Directions to “ KIMBERLY A PETRUSO DO” Practice Location

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