Provider Demographics
NPI:1194906065
Name:PETRAGLIA, CARMEN ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:ANTHONY
Last Name:PETRAGLIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2000 OXFORD DR
Mailing Address - Street 2:SUITE 211
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-1827
Mailing Address - Country:US
Mailing Address - Phone:412-283-0260
Mailing Address - Fax:412-283-0070
Practice Address - Street 1:2000 OXFORD DR
Practice Address - Street 2:SUITE 211
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-1827
Practice Address - Country:US
Practice Address - Phone:412-283-0260
Practice Address - Fax:412-283-0070
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD451111207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery