Active NPI
Jameson Moore Petrochko, MD
- Surgery Physician
- Fountain Hill, PA
National Provider Identifier
1962026062
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- MT220236
- Practice address
- 701 Ostrum St Ste 202
Fountain Hill, PA 18015-1152 - Phone
- (484) 526-2200
- NPI assigned
- Jun 4, 2020
- 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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | MT220236 | PA | Primary |
Addresses
Primary practice location
701 Ostrum St Ste 202
Fountain Hill, PA 18015-1152
Mailing address
701 Ostrum St Ste 202
Fountain Hill, PA 18015-1152
Phone (484) 526-2200
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT220236 | PA | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1591228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1591228800000",
"number": "1962026062",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "701 OSTRUM ST STE 202",
"city": "FOUNTAIN HILL",
"state": "PA",
"postal_code": "180151152",
"telephone_number": "484-526-2200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 OSTRUM ST STE 202",
"city": "FOUNTAIN HILL",
"state": "PA",
"postal_code": "180151152",
"telephone_number": "484-526-2200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETROCHKO",
"first_name": "JAMESON",
"middle_name": "MOORE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-06-04",
"last_updated": "2020-06-04",
"certification_date": "2020-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "PA",
"license": "MT220236",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fountain Hill, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.