Provider Demographics
NPI:1780087858
Name:PETRO HEALTH LLC
Entity type:Organization
Organization Name:PETRO HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ARMEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-317-1609
Mailing Address - Street 1:4021 ZUNI CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-5448
Mailing Address - Country:US
Mailing Address - Phone:410-487-6902
Mailing Address - Fax:410-487-6982
Practice Address - Street 1:1403 MADISON PARK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-6189
Practice Address - Country:US
Practice Address - Phone:202-317-1609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-03
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD75893261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care