Provider Demographics
NPI:1104953785
Name:PETRI, WILLIAM A JR (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:PETRI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LEE STREET, 4TH FLOOR
Practice Address - Street 2:UVA PRIMARY CARE CENTER
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903
Practice Address - Country:US
Practice Address - Phone:434-982-1700
Practice Address - Fax:434-924-0075
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101042142207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006032257Medicaid
VA110002112Medicare PIN
VAB08506Medicare UPIN