Provider Demographics
NPI:1255623690
Name:PETRUCCELLI, GABRIEL L (MD)
Entity type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:L
Last Name:PETRUCCELLI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1400 FOREST GLEN ROAD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1482
Mailing Address - Country:US
Mailing Address - Phone:301-589-3324
Mailing Address - Fax:301-681-7575
Practice Address - Street 1:1400 FOREST GLEN ROAD
Practice Address - Street 2:SUITE 400
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1482
Practice Address - Country:US
Practice Address - Phone:301-589-3324
Practice Address - Fax:301-681-7575
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2012-10-12
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Provider Licenses
StateLicense IDTaxonomies
CAA117457207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery