Provider Demographics
NPI:1316940208
Name:PERKOWSKI, VINCENT E (DO)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:E
Last Name:PERKOWSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7580 NORTHCLIFF AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:BROOKLYN
Mailing Address - State:OH
Mailing Address - Zip Code:44144-3272
Mailing Address - Country:US
Mailing Address - Phone:216-472-2741
Mailing Address - Fax:216-472-2739
Practice Address - Street 1:3300 BAILEY ST NW
Practice Address - Street 2:SUITE 102
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-3613
Practice Address - Country:US
Practice Address - Phone:330-834-9761
Practice Address - Fax:330-834-9765
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34006173207Q00000X
OH34-006173207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0241625Medicaid
OH0241625Medicaid
OHPE4094001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
OHH015810Medicare PIN