Provider Demographics
NPI:1952502577
Name:PETETTI, DONALD ANTHONY SR (DO)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:ANTHONY
Last Name:PETETTI
Suffix:SR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 TOOKANY CREEK PARKWAY
Mailing Address - Street 2:
Mailing Address - City:CHELTENHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19012
Mailing Address - Country:US
Mailing Address - Phone:215-782-1539
Mailing Address - Fax:
Practice Address - Street 1:111 TOOKANY CREEK PARKWAY
Practice Address - Street 2:
Practice Address - City:CHELTENHAM
Practice Address - State:PA
Practice Address - Zip Code:19012
Practice Address - Country:US
Practice Address - Phone:215-782-1539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOOS001943L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine