Provider Demographics
NPI:1184804130
Name:DAVID M. PETRO D.O.,M.P.H.
Entity type:Organization
Organization Name:DAVID M. PETRO D.O.,M.P.H.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:PETRO
Authorized Official - Suffix:
Authorized Official - Credentials:DO,MPH
Authorized Official - Phone:215-943-0424
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19058-0669
Mailing Address - Country:US
Mailing Address - Phone:215-943-0424
Mailing Address - Fax:215-943-8665
Practice Address - Street 1:200 JUNEWOOD DR
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19055-2324
Practice Address - Country:US
Practice Address - Phone:215-943-0424
Practice Address - Fax:215-943-8665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004383L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty