Provider Demographics
NPI:1316066038
Name:PETROVA, OLGA V (PA-C)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:V
Last Name:PETROVA
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:200 HYGEIA DR
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2049
Mailing Address - Country:US
Mailing Address - Phone:302-234-8853
Mailing Address - Fax:
Practice Address - Street 1:2600 GLASGOW AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-4773
Practice Address - Country:US
Practice Address - Phone:302-836-8350
Practice Address - Fax:302-836-8370
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2016-01-04
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Provider Licenses
StateLicense IDTaxonomies
DEC50000368363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical