Individual
MARK PETRUZZIELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
101 CLINIC DR, TARBORO, NC 27886-1935
(252) 823-2105
Mailing address
101 CLINIC DR, TARBORO, NC 27886-1935
(252) 823-2105
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
200001243
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020047543
RAILROAD MEDICARE
NC
01
—
127R6
BCBS
NC
01
—
1756614
UNITED HEALTHCARE
NC
05
—
89127R6
—
NC
01
—
A1917
MEDCOST
NC
Enumeration date
01/23/2006
Last updated
01/12/2022
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