Michael J Petti
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Middle River, MD
NPI 1295548618 · NPPES record last updated Jan 29, 2025
Key facts
- NPI
- 1295548618
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- R113240 (MD)
- Practice address
- 11560 Crossroads Cir Ste 10221220
Middle River, MD 21220-2885 - Phone
- (410) 508-0722
- NPI assigned
- Jan 29, 2025
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R113240 | MD | MD | Psychiatric/Mental Health Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | R113240 | MD | Yes |
Addresses
Primary practice location
11560 Crossroads Cir Ste 10221220
Middle River, MD 21220-2885
Mailing address
11560 Crossroads Cir Ste 10221220
Middle River, MD 21220-2885
Phone (410) 508-0722
Other providers in Middle River, MD
- Ritesh D Patel
- Kimberly Paul
- Erica L Payne
- Peace of Mind Support Services Inc.
- People Encouraging People, Inc.
- Kizzy Dianna Pittrell
- Plus Essentials Healthcare Services Corp
- Kimberly Rose Podhorniak
- Nicholas Konstantinos Polikandriotis
- Premise Health of Maryland Medical P C
All providers in Middle River, MD · Psychiatric/Mental Health Nurse Practitioner in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 29, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.