Provider Demographics
NPI:1306043195
Name:PETROFF, LINDA (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:PETROFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5360 JACKSON DR
Mailing Address - Street 2:STE 218D
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-6004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1275 YORK AVE
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY, MSKCC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-6007
Practice Address - Country:US
Practice Address - Phone:212-639-5914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239571207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology