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Individual

CARLA MARIE PETRONGOLO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
3400 SPRUCE ST, 9 FOUNDERS, PHILADELPHIA, PA 19104-4238
(215) 615-6005
Mailing address
3400 SPRUCE ST, 9 FOUNDERS, PHILADELPHIA, PA 19104-4238
(215) 615-6005

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
018505
NY
363A00000X
Physician Assistant
Primary
MA057507
PA

Other

Enumeration date
03/16/2015
Last updated
04/13/2017
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