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Individual

DR. MATTHEW SHANE PETRIE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
3055 WASHINGTON RD, SUITE 203, MC MURRAY, PA 15317-3279
(724) 260-5424
(724) 260-5425
Mailing address
3055 WASHINGTON RD, SUITE 203, MC MURRAY, PA 15317-3279
(724) 260-5424
(724) 260-5425

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
D72126
MD
207N00000X
Dermatology Physician
MD438908
PA
207ND0101X
MOHS-Micrographic Surgery Physician
D72126
MD
207ND0101X
MOHS-Micrographic Surgery Physician
MD438908
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
102851711-0002
PA
Enumeration date
05/30/2007
Last updated
01/09/2018
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