Provider Demographics
NPI:1851316905
Name:PETROSKI, DOUGLAS M (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:M
Last Name:PETROSKI
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 1:68 QUAKER RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-1711
Mailing Address - Country:US
Mailing Address - Phone:518-793-5601
Mailing Address - Fax:518-793-5916
Practice Address - Street 1:68 QUAKER RD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-1711
Practice Address - Country:US
Practice Address - Phone:518-793-5601
Practice Address - Fax:518-793-5916
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY134641207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00500243Medicaid
NYC49883Medicare UPIN
NY00500243Medicaid