Provider Demographics
NPI:1811988256
Name:PETRILLA, EUGENE FRANCIS (DO)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:FRANCIS
Last Name:PETRILLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RITTMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44270-1140
Mailing Address - Country:US
Mailing Address - Phone:330-925-4911
Mailing Address - Fax:330-927-9258
Practice Address - Street 1:223 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RITTMAN
Practice Address - State:OH
Practice Address - Zip Code:44270-1140
Practice Address - Country:US
Practice Address - Phone:330-925-4911
Practice Address - Fax:330-927-9258
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004170P207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0748927Medicaid
OH0616653OtherMEDICARE ID
OHPE0616652OtherMEDICARE ID
OHPE0616652OtherMEDICARE ID