Individual
DR. ANTHONY PETRACCA JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3 IRONGATE CENTER, GLENS FALLS, NY 12801-3471
(518) 793-4409
(518) 793-5886
Mailing address
3 IRONGATE CENTER, GLENS FALLS, NY 12801-3471
(518) 793-4409
(518) 793-5886
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
167575
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000056116
GHI-HMO
NY
01
—
00020592301
UNIVERA
NY
01
—
000401245001
BLUE SHIELD NENY
NY
05
—
01346818
—
NY
01
—
021200700350
FIDELIS
NY
01
—
08219
MVP
NY
01
—
10002650
CDPHP
NY
01
—
10470641
CAQH
NY
01
—
5500215
AETNA
NY
01
—
56K521
BLUE CROSS BLUE SHIELD
NY
01
—
CD1981
RAILROAD MEDICARE GROUP #
NY
Enumeration date
11/19/2005
Last updated
02/13/2008
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