Petakov, Dragan S

Petakov, Dragan S is an individual health care provider with primary practice located at 275 Varnum Ave Ste 201, Lowell MA 01854. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Petakov, Dragan S can be contacted via phone (978) 452-9700.

Contact Information

Primary practice address
275 Varnum Ave Ste 201 Lowell MA 01854
Phone: (978) 452-9700
Fax: (978) 441-6075
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 157347 Massachusetts

Profile Details

NPI number 1629030622
LBN Legal business name Petakov, Dragan S
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 5th, 2006
Last updated May 16th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1629030622 NPPES
Massachusetts MEDICAID 0160750
Massachusetts Other J24518
Massachusetts MEDICAID 0158658

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