MEDICARE: MARK G PETRIZZI 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	207Q00000X	Family Medicine Physician	0101046079	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	:	1336152511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK G PETRIZZI MD

Provider Business Mailing Address
First Line	:	3400 HAYDENPARK LN STE 300
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23233-7867
Country	:	US
Telephone Number	:	804-998-1600
Fax Number	:	804-998-1601

Provider Business Practice Location Address
First Line	:	3400 HAYDENPARK LN STE 300
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23233-7867
Country	:	US
Telephone Number	:	804-998-1600
Fax Number	:	804-998-1601

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	02/25/2021

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Directions to “ MARK G PETRIZZI MD” Practice Location

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