Provider Demographics
NPI:1487750980
Name:PETRINITZ, JEFFREY A (DPM)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:PETRINITZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2706 SAINT JUDE ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-3670
Mailing Address - Country:US
Mailing Address - Phone:336-375-6990
Mailing Address - Fax:336-375-0361
Practice Address - Street 1:2706 SAINT JUDE ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-3670
Practice Address - Country:US
Practice Address - Phone:336-375-6990
Practice Address - Fax:336-375-0361
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2010-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC212213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
54073OtherMEDCAST
67229OtherBCBS
NC8967229Medicaid
54073OtherMEDCAST
NC8967229Medicaid