Individual
DR. LAURA R FAGIOLI PETRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
15 PARKMAN ST, WAC 812, BOSTON, MA 02114-3117
(617) 724-6300
(617) 726-7541
Mailing address
PO BOX 9142, CHARLESTOWN, MA 02129-9142
(617) 724-0287
(617) 726-2894
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
209225
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2041740
—
MA
01
—
468911
TUFTS HEALTH PLAN
MA
01
—
J27347
BCBS MA
MA
Enumeration date
11/16/2005
Last updated
11/01/2012
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