MEDICARE: DR. EUGENE A PETRASY DDS

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
1	122300000X	Dentist	0401003524	VA

General Provider Information

NPI Number	:	1043438393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EUGENE A PETRASY DDS

Provider Business Mailing Address
First Line	:	3129 STONY POINT RD APT C
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-2364
Country	:	US
Telephone Number	:	804-560-3422
Fax Number	:

Provider Business Practice Location Address
First Line	:	5303 PLAZA DR
Second Line	:	SUITE 103
City	:	HOPEWELL
State	:	VA
Zip	:	23860-7331
Country	:	US
Telephone Number	:	804-458-5047
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	07/08/2007

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