MEDICARE: DR. DENNIS PETROCELLI MD

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	2084P0800X	Psychiatry Physician	0101225205	VA
2	2084P0804X	Child & Adolescent Psychiatry Physician	0101225205	VA
3	2084F0202X	Forensic Psychiatry Physician	0101225205	VA
4	2084P0802X	Addiction Psychiatry Physician	0101225205	VA

General Provider Information

NPI Number	:	1326026816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS PETROCELLI MD

Provider Business Mailing Address
First Line	:	PO BOX 1824
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-9108
Country	:	US
Telephone Number	:	804-717-5181
Fax Number	:	888-274-9835

Provider Business Practice Location Address
First Line	:	9512 IRON BRIDGE RD
Second Line	:	SUITE 201
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-6458
Country	:	US
Telephone Number	:	804-717-5181
Fax Number	:	888-274-9835

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

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	11/22/2013

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