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NPI Code Detail

MEDICARE: JOANNE M PETRO PA C

MEDICARE: JOANNE M PETRO PA C
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
1363A00000XPhysician AssistantOA002169PA
2363A00000XPhysician AssistantMA000608LPA

General Provider Information

NPI Number : 1265486195
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOANNE M PETRO PA C
Provider Business Mailing Address
First Line : 100 N ACADEMY AVE
Second Line :
City : DANVILLE
State : PA
Zip : 17822-4903
Country : US
Telephone Number : 570-271-6144
Fax Number : 570-271-6578
Provider Business Practice Location Address
First Line : 35 S MOUNTAIN BLVD
Second Line :
City : MOUNTAIN TOP
State : PA
Zip : 18707-1122
Country : US
Telephone Number : 570-474-5847
Fax Number : 570-474-6952
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2006
Last Update Date : 12/21/2020

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Directions to “ JOANNE M PETRO PA C” Practice Location

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