Provider Demographics
NPI:1740436195
Name:PETRILLO, SARA PINGUL II (MD)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:PINGUL
Last Name:PETRILLO
Suffix:II
Gender:F
Credentials:MD
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Mailing Address - Street 1:125 METRO CENTER BLVD SUITE 2000
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886
Mailing Address - Country:US
Mailing Address - Phone:401-432-2500
Mailing Address - Fax:401-889-3619
Practice Address - Street 1:593 EDDY STREET
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-5374
Practice Address - Country:US
Practice Address - Phone:401-444-5174
Practice Address - Fax:401-889-3619
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA10165932085R0202X
MDD00685742085R0202X
VA01012450562085R0202X
DCMD0371492085R0202X
RIMD192882085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology