Provider Demographics
NPI:1104037118
Name:PETRARCA, STEVEN ALAN (OST CPED)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:ALAN
Last Name:PETRARCA
Suffix:
Gender:M
Credentials:OST CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 FRENCHTOWN ROAD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-1783
Mailing Address - Country:US
Mailing Address - Phone:401-885-5004
Mailing Address - Fax:401-885-8283
Practice Address - Street 1:135 FRENCHTOWN ROAD
Practice Address - Street 2:SUITE 4
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-1783
Practice Address - Country:US
Practice Address - Phone:401-885-5004
Practice Address - Fax:401-885-8283
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
408288OtherBLUE CHIP
29672OtherBLUE CROSS
29672OtherBLUE CROSS