Provider Demographics
NPI:1144859778
Name:PETRERA, MATTEO (MD)
Entity type:Individual
Prefix:
First Name:MATTEO
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 1:1706 PINE ST APT 3F
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6766
Mailing Address - Country:US
Mailing Address - Phone:443-880-2573
Mailing Address - Fax:
Practice Address - Street 1:111 S 11TH ST STE 8290
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4824
Practice Address - Country:US
Practice Address - Phone:215-955-2370
Practice Address - Fax:215-955-0677
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD484942207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology