Individual
DAVID J PETILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
111 GROSSMAN DR, BRAINTREE, MA 02184-4997
(781) 849-1000
Mailing address
111 GROSSMAN DR, BRAINTREE, MA 02184-4997
(781) 849-1000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
72186
MA
207R00000X
Internal Medicine Physician
Primary
72186
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3115062
—
MA
Enumeration date
07/12/2006
Last updated
02/24/2020
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