Provider Demographics
NPI:1568490878
Name:PETRU, ANN MARGARET (MD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:MARGARET
Last Name:PETRU
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 1:43 AGNES ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-2522
Mailing Address - Country:US
Mailing Address - Phone:510-428-3337
Mailing Address - Fax:510-601-3957
Practice Address - Street 1:747 FIFTY-SECOND STREET
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1809
Practice Address - Country:US
Practice Address - Phone:510-428-3337
Practice Address - Fax:510-601-3957
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40627208000000X, 2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACGP160130OtherCCS CONSULTANT NUMBER
CA00G406270Medicaid
CACGP 089750OtherCCS PROVIDER NUMBER
CACGP 089750OtherCCS PROVIDER NUMBER
CACGP160130OtherCCS CONSULTANT NUMBER