Provider Demographics
NPI:1760490916
Name:PETTRONE, KRISTEN AIMEE (MD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:AIMEE
Last Name:PETTRONE
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:PO BOX 1150
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25402-1150
Mailing Address - Country:US
Mailing Address - Phone:304-264-1000
Mailing Address - Fax:304-264-1374
Practice Address - Street 1:2500 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25402-1150
Practice Address - Country:US
Practice Address - Phone:304-264-1000
Practice Address - Fax:304-264-1374
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22745207P00000X
NC2003-00680207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN00685Medicaid
NC89135JUMedicaid
NC89135JUMedicaid
NCH95667Medicare UPIN