Provider Demographics
NPI:1225200900
Name:PETRELA, EVIS (MD)
Entity Type:Individual
Prefix:
First Name:EVIS
Middle Name:
Last Name:PETRELA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4900 BROAD RD
Mailing Address - Street 2:SUITE 3P
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-2265
Mailing Address - Country:US
Mailing Address - Phone:315-492-5910
Mailing Address - Fax:315-492-5950
Practice Address - Street 1:4900 BROAD RD
Practice Address - Street 2:SUITE 3P
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-2265
Practice Address - Country:US
Practice Address - Phone:315-492-5910
Practice Address - Fax:315-492-5950
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY003023207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology