Individual
CONSTANTINE N PETROCHKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
110 N MAIN ST, GREENVILLE, PA 16125-1726
(724) 588-2100
Mailing address
PO BOX 73985, CLEVELAND, OH 44193-0002
(866) 338-6467
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD052081L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000114390
BC BS
OH
05
—
0015251910001
—
PA
05
—
0381466
—
OH
01
—
0690975
BC BS
PA
Enumeration date
02/13/2006
Last updated
07/18/2007
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