Provider Demographics
NPI:1386641561
Name:PETROSINO, ALBERT THADDEUS (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:THADDEUS
Last Name:PETROSINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 59TH ST W STE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-7021
Mailing Address - Country:US
Mailing Address - Phone:941-794-5732
Mailing Address - Fax:
Practice Address - Street 1:2902 59TH ST W STE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-7021
Practice Address - Country:US
Practice Address - Phone:941-794-5732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-04
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67012207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF90032Medicare UPIN
FLF90032Medicare UPIN