| Robert Alan Petry Pc | |
|
6964 Forest Hill Ave Richmond VA 23225-1659 | |
| (804) 320-7738 | |
| (804) 320-8738 |
| Full Name | Robert Alan Petry Pc |
|---|---|
| Speciality | Psychologist |
| Location | 6964 Forest Hill Ave, Richmond, Virginia |
| Authorized Official Name and Position | Robert Alan Petry (OWNER) |
| Authorized Official Contact | 8043207738 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Robert Alan Petry Pc 6964 Forest Hill Ave Richmond VA 23225-1659 Ph: (804) 320-7738 | Robert Alan Petry Pc 6964 Forest Hill Ave Richmond VA 23225-1659 Ph: (804) 320-7738 |
| NPI Number | 1104151125 |
|---|---|
| Provider Enumeration Date | 10/08/2009 |
| Last Update Date | 04/22/2013 |
| Medicare PECOS PAC ID | 9739221185 |
|---|---|
| Medicare Enrollment ID | O20100122000383 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104151125 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 0810002340 (Virginia) | Primary |
| Provider Name | Robert A Petry |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1790874154 PECOS PAC ID: 3072652866 Enrollment ID: I20100106000453 |
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