Provider Demographics
NPI:1811287014
Name:PETROZZINO, VITO ANIELLO (MD)
Entity type:Individual
Prefix:DR
First Name:VITO
Middle Name:ANIELLO
Last Name:PETROZZINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 OCEAN SHORE BLVD
Mailing Address - Street 2:APT 206
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-2521
Mailing Address - Country:US
Mailing Address - Phone:201-787-7651
Mailing Address - Fax:
Practice Address - Street 1:2860 OCEAN SHORE BLVD
Practice Address - Street 2:APT 206
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176-2521
Practice Address - Country:US
Practice Address - Phone:201-787-7651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-09
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME123472207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine