Provider Demographics
NPI:1487465357
Name:PETRY, ANDREW JAMES (PA-C)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:JAMES
Last Name:PETRY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4340 CLYO RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-7000
Mailing Address - Country:US
Mailing Address - Phone:937-534-7330
Mailing Address - Fax:937-297-2203
Practice Address - Street 1:4340 CLYO RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-7000
Practice Address - Country:US
Practice Address - Phone:937-534-7330
Practice Address - Fax:937-297-2203
Is Sole Proprietor?:No
Enumeration Date:2025-01-18
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.009368RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant