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NPI Code Detail

MEDICARE: DR. FRANK P PETTINELLI D.O.

MEDICARE: DR. FRANK P PETTINELLI D.O.
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 PhysicianMB44700NJ

General Provider Information

NPI Number : 1215979307
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. FRANK P PETTINELLI D.O.
Provider Business Mailing Address
First Line : 3814 CHURCH RD
Second Line :
City : MOUNT LAUREL
State : NJ
Zip : 08054-1106
Country : US
Telephone Number : 856-231-9792
Fax Number : 856-231-9862
Provider Business Practice Location Address
First Line : 3814 CHURCH RD
Second Line :
City : MOUNT LAUREL
State : NJ
Zip : 08054-1106
Country : US
Telephone Number : 856-231-9792
Fax Number : 856-231-9862
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2006
Last Update Date : 07/08/2007

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