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Individual

ELISSA PETTINATO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
561 FAIRTHORNE AVE, PHILADELPHIA, PA 19128-2412
(800) 235-0200
Mailing address
5443 HOUGHTON PL, APT. 1, PHILADELPHIA, PA 19128-2816
(814) 227-8403

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
25MP00429700
NJ
363A00000X
Physician Assistant
OA004035
PA
363AM0700X
Medical Physician Assistant
Primary
MA058812
PA

Other

Enumeration date
04/12/2017
Last updated
04/12/2017
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