Provider Demographics
NPI:1508203274
Name:PETRAGLIA, ALYCIA ANN (DO)
Entity Type:Individual
Prefix:
First Name:ALYCIA
Middle Name:ANN
Last Name:PETRAGLIA
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 1:4814 LOLLY DR
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3628
Mailing Address - Country:US
Mailing Address - Phone:412-373-3465
Mailing Address - Fax:
Practice Address - Street 1:1500 FIFTH AVE
Practice Address - Street 2:UPMC MCKEESPORT INTERNAL MEDICINE CENTER
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15132-2422
Practice Address - Country:US
Practice Address - Phone:412-664-2167
Practice Address - Fax:412-664-2164
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS018197207R00000X
PAOT 015101390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program