Provider Demographics
NPI:1740339092
Name:PETKO, JAMES MICHAEL (DPM)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:PETKO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6716 ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-2105
Mailing Address - Country:US
Mailing Address - Phone:703-533-1900
Mailing Address - Fax:703-532-3332
Practice Address - Street 1:6716 ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-2105
Practice Address - Country:US
Practice Address - Phone:703-533-1900
Practice Address - Fax:703-532-3332
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000682213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA480005209OtherRAILROAD MEDICARE NUMBER
VAT30951Medicare UPIN