Provider Demographics
NPI:1164445482
Name:PETRONE, LOUIS R (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:R
Last Name:PETRONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2100 SPRING GARDEN STREET
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3502
Mailing Address - Country:US
Mailing Address - Phone:215-955-9655
Mailing Address - Fax:215-988-0545
Practice Address - Street 1:2100 SPRING GARDEN STREET
Practice Address - Street 2:1ST FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-3502
Practice Address - Country:US
Practice Address - Phone:215-955-9655
Practice Address - Fax:215-988-0545
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD042536E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011619730007Medicaid
PA0011619730007Medicaid