Provider Demographics
NPI:1346803699
Name:PETRASH, NOREEN MICHELE (DO)
Entity Type:Individual
Prefix:DR
First Name:NOREEN
Middle Name:MICHELE
Last Name:PETRASH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 980257
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-0257
Mailing Address - Country:US
Mailing Address - Phone:804-828-9783
Mailing Address - Fax:
Practice Address - Street 1:VCUHS DEPT OF PEDIATRIC EMERGENCY MEDICINE FELLOWSHIP
Practice Address - Street 2:1250 E. MARSHALL STREET
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-0257
Practice Address - Country:US
Practice Address - Phone:804-828-2467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0102207966390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program