MEDICARE: DR. VIRGINIA BURNS PETITTO 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	207W00000X	Ophthalmology Physician	ME63378	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	18447Y	OTHER	FL	MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	18447	OTHER	FL	BLUE CROSS BLUE SHIELD FL
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588624407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIRGINIA BURNS PETITTO M.D.

Provider Business Mailing Address
First Line	:	4340 NEWBERRY RD.
Second Line	:	SUITE 301
City	:	GAINESVILLE
State	:	FL
Zip	:	32607-2557
Country	:	US
Telephone Number	:	352-372-9414
Fax Number	:	352-271-5393

Provider Business Practice Location Address
First Line	:	4340 NEWBERRY RD.
Second Line	:	SUITE 301
City	:	GAINESVILLE
State	:	FL
Zip	:	32607-2557
Country	:	US
Telephone Number	:	352-372-9414
Fax Number	:	352-271-5393

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	07/16/2014

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Directions to “ DR. VIRGINIA BURNS PETITTO M.D.” Practice Location

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