Provider Demographics
NPI:1427025907
Name:PETROSKY, PATRICIA P (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:P
Last Name:PETROSKY
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 1:150 LOWER WESTFIELD RD
Mailing Address - Street 2:STE1
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-2767
Mailing Address - Country:US
Mailing Address - Phone:413-536-2393
Mailing Address - Fax:413-536-1087
Practice Address - Street 1:150 LOWER WESTFIELD RD
Practice Address - Street 2:STE1
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-2767
Practice Address - Country:US
Practice Address - Phone:413-536-2393
Practice Address - Fax:413-536-1087
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205094208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3138691Medicaid
MA3138691Medicaid
MAA20349Medicare PIN