Provider Demographics
NPI:1972381077
Name:PETLOCK, ANDREW G (PA)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:G
Last Name:PETLOCK
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Gender:M
Credentials:PA
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Mailing Address - Street 1:171 MAIN ST STE 203B
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-1187
Mailing Address - Country:US
Mailing Address - Phone:508-881-3029
Mailing Address - Fax:508-881-1752
Practice Address - Street 1:1 CABOT RD STE 101
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-2963
Practice Address - Country:US
Practice Address - Phone:978-562-3536
Practice Address - Fax:978-562-4626
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2024-10-01
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant