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Individual

DR. ROBERT JOHN PETRELLA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1153 CENTRE ST, FAULKNER HOSPITAL EMERGENCY DEPARTMENT, BOSTON, MA 02130-3446
(617) 983-7700
Mailing address
103 SANBORN AVE, WEST ROXBURY, MA 02132-3834
(617) 323-6676

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
75111
MA
207R00000X
Internal Medicine Physician
75111
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
075111
TUFTS
MA
05
3110613
MA
01
J13837
BLUE SHIELD
MA
Enumeration date
06/19/2006
Last updated
07/01/2008
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