Individual
DR. JOSEPH C PETROCELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
910 WALLACE AVE, LEITCHFIELD, KY 42754-2414
(270) 259-3035
Mailing address
910 WALLACE AVE, LEITCHFIELD, KY 42754-2414
(270) 259-3035
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
20679
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000050793
ANTHEM
KY
01
—
1054879
PASSPORT
KY
01
—
2433736000
PASSPORT ADVANTAGE
KY
01
—
611269278001
CHAMPUS
KY
05
—
64206790
—
KY
Enumeration date
05/27/2005
Last updated
02/01/2012
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