Provider Demographics
NPI:1053542118
Name:PETRI, JUSTIN D (MD)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:D
Last Name:PETRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-5888
Mailing Address - Fax:757-446-5918
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 710
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-5888
Practice Address - Fax:757-446-5918
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01012470262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA406418OtherANTHEM BC/BS
VAPAROtherMHN/TRICARE
NC5914288Medicaid
VAPAROtherVA HEALTH NETWORK
VAPAROtherVA PREMIER HEALTH (EVMS HEALTH SERVICES)
VAPAROtherFIRST HEALTH COMMERCIAL
VAPAROtherUSA MANAGED CARE (EVMS HEALTH SERVICES)
VAPAROtherCIGNA BEHAVIORAL HEALTH
VAPAROtherAETNA (EVMS HEALTH SERVICES)
VA1053542118OtherOPTIMA BEHAVIORAL HEALTH
VAPAROtherMULTIPLAN
VA1053542118Medicaid
VAPAROtherVALUE OPTIONS
VAPAROtherCORVEL/CORCARE
VAPAROtherMAGELLAN HEALTH SERVICES
VAPAROtherUNITED BEHAVIORAL HEALTH
VAPAROtherCORVEL/CORCARE
VAPAROtherUSA MANAGED CARE (EVMS HEALTH SERVICES)