MEDICARE: JANE VERONICA PETROFF M.D.

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	207K00000X	Allergy & Immunology Physician	022321	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063446698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE VERONICA PETROFF M.D.

Provider Business Mailing Address
First Line	:	57 NORTH ST STE 216
Second Line	:
City	:	DANBURY
State	:	CT
Zip	:	06810-5627
Country	:	US
Telephone Number	:	203-797-9209
Fax Number	:	203-748-7692

Provider Business Practice Location Address
First Line	:	57 NORTH ST STE 216
Second Line	:
City	:	DANBURY
State	:	CT
Zip	:	06810-5627
Country	:	US
Telephone Number	:	203-797-9209
Fax Number	:	203-748-7692

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	12/11/2007

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