Active NPI
Martin A. Petrillo, CLINICAL PSYCH
- Clinical Psychologist
- Annapolis, MD
National Provider Identifier
1407828643
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 03157
- Practice address
- 250 Wood Rd
Annapolis, MD 21402-1257 - Phone
- (410) 293-4378
- NPI assigned
- Feb 2, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 03157 | MD | Primary |
Addresses
Primary practice location
250 Wood Rd
Annapolis, MD 21402-1257
Mailing address
250 Wood Rd
Annapolis, MD 21402-1257
Phone (410) 293-4378
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03157 | MD | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138838400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1407828643",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "250 WOOD RD",
"city": "ANNAPOLIS",
"state": "MD",
"postal_code": "214021257",
"telephone_number": "410-293-4378"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "250 WOOD RD",
"city": "ANNAPOLIS",
"state": "MD",
"postal_code": "214021257",
"telephone_number": "410-293-4378"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRILLO",
"first_name": "MARTIN",
"middle_name": "A.",
"credential": "CLINICAL PSYCH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-02",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MD",
"license": "03157",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Annapolis, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.