Provider Demographics
NPI:1548604507
Name:PETRIE, TRISTAN DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:TRISTAN
Middle Name:DONALD
Last Name:PETRIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1001 W FAYETTE ST STE 400
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2866
Mailing Address - Country:US
Mailing Address - Phone:315-937-3433
Mailing Address - Fax:315-475-2357
Practice Address - Street 1:739 IRVING AVE STE 500
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1664
Practice Address - Country:US
Practice Address - Phone:315-470-7409
Practice Address - Fax:315-475-2357
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY285711207RC0000X, 207RC0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program