Provider Demographics
NPI:1053362236
Name:PETROZZI, ROCCO ANTHONY JR (DPM)
Entity type:Individual
Prefix:DR
First Name:ROCCO
Middle Name:ANTHONY
Last Name:PETROZZI
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 N SHORE DR
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-4679
Mailing Address - Country:US
Mailing Address - Phone:440-290-5327
Mailing Address - Fax:
Practice Address - Street 1:7000 EUCLID AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-4014
Practice Address - Country:US
Practice Address - Phone:216-231-5612
Practice Address - Fax:216-721-5534
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003393213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH358227OtherSTAYWELL/WELLCARE
OH000000564733OtherANTHEM BLUE CROSS BLUE SHIELD
OH000000564757OtherANTHEM BLUE CROSS BLUE SHIELD
OH2675930Medicaid
OHP00656043OtherRAIL ROAD MEDICARE CFAI
000000484990OtherANTHEM BCBS
7263866OtherAETNA-LIFE & CASUALTY CO.
V10227Medicare UPIN
7263866OtherAETNA-LIFE & CASUALTY CO.
OH4192966Medicare PIN
OH4192962Medicare PIN
OHP00429530Medicare PIN
OH4192967Medicare PIN
OH2675930Medicaid
OH000000564757OtherANTHEM BLUE CROSS BLUE SHIELD