Provider Demographics
NPI:1598859761
Name:GURTNER, PETRA (MD)
Entity Type:Individual
Prefix:DR
First Name:PETRA
Middle Name:
Last Name:GURTNER
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 1:229 W BUTE ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1405
Mailing Address - Country:US
Mailing Address - Phone:757-622-1003
Mailing Address - Fax:757-622-1108
Practice Address - Street 1:229 W BUTE ST
Practice Address - Street 2:SUITE 800
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1405
Practice Address - Country:US
Practice Address - Phone:757-622-1003
Practice Address - Fax:757-622-1108
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056357207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1400005733OtherRAILROAD MEDICARE
VA213281OtherCIGNA
VA257818OtherANTHEM
VA541375516OtherFIRST HEALTH
VA0004462765OtherAETNA
VA6104916Medicaid
VA11481OtherOPTIMA
NC790556QMedicaid
NC790556QMedicaid
VA0004462765OtherAETNA