MEDICARE: PAUL J PETROZZO 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	2085R0202X	Diagnostic Radiology Physician	0101237174	VA

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	:	1184625337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL J PETROZZO M.D.

Provider Business Mailing Address
First Line	:	116 FAIRVIEW ST
Second Line	:
City	:	GRUNDY
State	:	VA
Zip	:	24614-9415
Country	:	US
Telephone Number	:	276-935-8268
Fax Number	:

Provider Business Practice Location Address
First Line	:	RR 5 BOX 20
Second Line	:	STATE ROUTE 83
City	:	GRUNDY
State	:	VA
Zip	:	24614-9611
Country	:	US
Telephone Number	:	276-523-7938
Fax Number	:

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	03/13/2015

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