Basic Information
| Provider Information | |||||||||
| NPI: | 1629058201 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PETRELLI | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 30170 | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198057170 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026237362 | ||||||||
| FaxNumber: | 3026237374 | ||||||||
| Practice Location | |||||||||
| Address1: | 4701 OGLETOWN STANTON RD | ||||||||
| Address2: | SUITE 1213 | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197132055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026234550 | ||||||||
| FaxNumber: | 3026234554 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2006 | ||||||||
| LastUpdateDate: | 12/21/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086X0206X | C1-0006443 | DE | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology |
No ID Information.