Provider Demographics
NPI:1811036981
Name:PETCU, EUGEN BOGDAN (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGEN
Middle Name:BOGDAN
Last Name:PETCU
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:GRIFFITH UNIV SCHOOL OF MEDICINE, DEPT OF PATHOLOGY
Mailing Address - Street 2:16-30 HIGH STREET
Mailing Address - City:SOUTHPORT
Mailing Address - State:QUEENSLAND
Mailing Address - Zip Code:4215
Mailing Address - Country:AU
Mailing Address - Phone:0116175-678-0761
Mailing Address - Fax:
Practice Address - Street 1:GRIFFITH UNIV SCHOOL OF MEDICINE, DEPT OF PATHOLOGY
Practice Address - Street 2:16-30 HIGH STREET
Practice Address - City:SOUTHPORT
Practice Address - State:QUEENSLAND
Practice Address - Zip Code:4215
Practice Address - Country:AU
Practice Address - Phone:0116175-678-0761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216274207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology