Provider Demographics
NPI:1396038154
Name:PETRICK, KATHLEEN PITTERLE (DO)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:PITTERLE
Last Name:PETRICK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:MARIE
Other - Last Name:PITTERLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1600 ROCKLAND ROAD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803
Mailing Address - Country:US
Mailing Address - Phone:302-651-4500
Mailing Address - Fax:302-651-4543
Practice Address - Street 1:1600 ROCKLAND ROAD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803
Practice Address - Country:US
Practice Address - Phone:302-651-4500
Practice Address - Fax:302-651-4543
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA262292208000000X
DEC2-00127222080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics