Nicholas Petri, DO

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

83718 Issued in SC

Practice address

96 Jonathan Lucas CSB 210, MSC 323
Charleston, SC 29425-6173

Phone

(843) 792-1767

NPI assigned

Apr 6, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749513600000",
    "number": "1144859729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1765 CORNSILK DR",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294148018",
            "telephone_number": "919-280-1299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "96 JONATHAN LUCAS CSB 210, MSC 323",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294256173",
            "telephone_number": "843-792-1767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRI",
        "first_name": "NICHOLAS",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-06",
        "last_updated": "2025-06-10",
        "certification_date": "2025-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": "SC",
            "license": "83718",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "SC",
            "license": "83718",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "SC",
            "license": "83718",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mae M Peterseim, MD
• Stephanie Lynn Petersen, FNP
• Amanda Peterson, RD
• Austin Peterson, DO
• Debra Petitpain, MS, LD, RD
• Ashleigh Marie Petrides, PNP
• Sydney Petrofske, DPT
• Benjamin Luigi Petrykowski, DO
• Allison Petschke, MD
• Richelle Lee Peveler, ANP

• Diagnostic Radiology Physician in Charleston, SC
• Providers in Charleston, SC by specialty
• Diagnostic Radiology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.