Basic Information
| Provider Information | |||||||||
| NPI: | 1356652994 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PETSCHNIGG | ||||||||
| FirstName: | EVA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 BOSTON MEDICAL CTR PL | ||||||||
| Address2: | DEPARTMENT OF MEDICINE | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176386500 | ||||||||
| FaxNumber: | 6176386501 | ||||||||
| Practice Location | |||||||||
| Address1: | 725 ALBANY ST | ||||||||
| Address2: | SHAPIRO 5, SUITE B | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174145951 | ||||||||
| FaxNumber: | 6176386501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2010 | ||||||||
| LastUpdateDate: | 06/13/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 245607 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.