Individual
DR. DOUGLAS MATTHEW PETRACO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6 TECHNOLOGY DR STE 100, EAST SETAUKET, NY 11733-4079
(631) 689-6698
(631) 751-5548
Mailing address
6 TECHNOLOGY DR STE 100, EAST SETAUKET, NY 11733-4079
(631) 689-6698
(631) 751-5548
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
195619
NY
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
195619
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02011645
—
NY
Enumeration date
07/25/2006
Last updated
03/18/2019
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