Provider Demographics
NPI:1215918933
Name:PETRERA, PASQUALE (MD)
Entity type:Individual
Prefix:DR
First Name:PASQUALE
Middle Name:
Last Name:PETRERA
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:PO BOX 2415
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-2415
Mailing Address - Country:US
Mailing Address - Phone:410-749-4154
Mailing Address - Fax:410-860-9583
Practice Address - Street 1:1675 WOODBROOKE DRIVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804
Practice Address - Country:US
Practice Address - Phone:410-749-4154
Practice Address - Fax:410-860-9583
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD44707207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
3226879OtherAETNA
MD588841700Medicaid
66G41OtherEMPIRE BCBS
VA006400248Medicaid
MD217742OtherMDIPA OPTIMUM CHOICE
DE0000575601Medicaid
221921800OtherUS DEPARTMENT OF LABOR
200022316OtherRAILROAD MEDICARE
327279OtherPRIME HEALTH
52819001H524PEOtherBCBS TRAD PRODUCTS
44707OtherFREESTATE DELMARVA HEALTH
0008W409OtherBCBS PROD FEP BLUE CHOICE
VA091051OtherTRIGON BCBS
221921800OtherUS DEPARTMENT OF LABOR
VA006400248Medicaid