Provider Demographics
NPI:1942337530
Name:PETRUCCI, MARIA ANTONETTE (DC)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ANTONETTE
Last Name:PETRUCCI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9145 GUILFORD ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-2576
Mailing Address - Country:US
Mailing Address - Phone:410-880-4215
Mailing Address - Fax:410-880-4192
Practice Address - Street 1:9145 GUILFORD ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2576
Practice Address - Country:US
Practice Address - Phone:410-880-4215
Practice Address - Fax:410-880-4192
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD41920704OtherBCBS RENDERING
MDM634OtherNON PAR BCBS
T59595Medicare UPIN
MD41920704OtherBCBS RENDERING