Provider Demographics
NPI:1245297001
Name:PETROSKI, RAYFORD A (MD)
Entity type:Individual
Prefix:
First Name:RAYFORD
Middle Name:A
Last Name:PETROSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:169 RIVERSIDE DRIVE
Mailing Address - Street 2:DEPAUL PAVILION
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4246
Mailing Address - Country:US
Mailing Address - Phone:607-729-7667
Mailing Address - Fax:607-729-7667
Practice Address - Street 1:169 RIVERSIDE DRIVE
Practice Address - Street 2:DEPAUL PAVILION
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4246
Practice Address - Country:US
Practice Address - Phone:607-729-7667
Practice Address - Fax:607-729-7667
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD068109L208800000X
NY258213208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology