Provider Demographics
NPI:1821292400
Name:PETRINI, BART EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:BART
Middle Name:EDWARD
Last Name:PETRINI
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 1:2701 W BAY AREA BLVD APT 2702
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-3136
Mailing Address - Country:US
Mailing Address - Phone:512-771-8189
Mailing Address - Fax:
Practice Address - Street 1:2701 W BAY AREA BLVD APT 2702
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-3136
Practice Address - Country:US
Practice Address - Phone:512-771-8189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7518207P00000X, 2085N0700X, 2085R0202X, 208D00000X
AZ553432085N0700X
WI2454-3202085R0202X
ND186932085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189372915Medicaid
TX8R9891OtherBCBS
TX189372914Medicaid
TX189372915Medicaid
TX8L12031Medicare PIN
879930003OtherMYUTMB 879930003-COMMERCIAL NUMBER
TX8L12126Medicare PIN