Provider Demographics
NPI:1932504727
Name:PETROLE, ANTHONY SALVADORE (PA-C)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:SALVADORE
Last Name:PETROLE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:356 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17921
Mailing Address - Country:US
Mailing Address - Phone:570-590-7287
Mailing Address - Fax:
Practice Address - Street 1:252 4TH STREET
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042
Practice Address - Country:US
Practice Address - Phone:717-270-7751
Practice Address - Fax:717-270-3877
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant