Provider Demographics
NPI:1629217807
Name:PETRILLO, ENRICO (MD)
Entity Type:Individual
Prefix:
First Name:ENRICO
Middle Name:
Last Name:PETRILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 STAFFORD RD
Mailing Address - Street 2:
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940-1462
Mailing Address - Country:US
Mailing Address - Phone:617-450-9800
Mailing Address - Fax:
Practice Address - Street 1:CB HEALTH VENTURES , L.L.C.
Practice Address - Street 2:800 BOYLSTON ST . SUITE 1585
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02199
Practice Address - Country:US
Practice Address - Phone:617-450-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA49975207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine