Individual
DR. MICHAEL A DEPETRILLO JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1201 NOTT ST, SUITE 106, SCHENECTADY, NY 12308-2589
(518) 374-3123
(518) 374-9711
Mailing address
1201 NOTT ST, SUITE 106, SCHENECTADY, NY 12308-2589
(518) 374-3123
(518) 374-9711
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
127532-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000097790
GHI HMO
—
01
—
000405064002
BLUE SHIELD NENY
—
01
—
000405064003
BLUE SHIELD NENY
—
05
—
00392847
—
NY
01
—
00A28
EMPIRE BLUE CROSS
—
01
—
040426006657
FIDELIS
—
01
—
05104
MVP
—
01
—
10000479
CDPHP
—
01
—
110160500
US DEPT OF LABOR
—
01
—
127532-1
TRICARE NORTH REGION
—
01
—
33570P
FIDELIS MEDICARE
—
01
—
9599341
GHI
—
01
—
CAN1275320
NO FAULT
—
01
—
D01979
AMERICAN PROGRESSIVE TODA
—
01
—
MD000A2810
EMPIRE BLUE CROSS
—
01
—
MD000A2820
EMPIRE BLUE CROSS
—
Enumeration date
07/29/2005
Last updated
11/10/2010
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