Provider Demographics
NPI:1316986326
Name:PEREIRA, GEORGE J (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:J
Last Name:PEREIRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 WINTHROP ST
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-4355
Mailing Address - Country:US
Mailing Address - Phone:508-824-7400
Mailing Address - Fax:
Practice Address - Street 1:152 DEAN ST
Practice Address - Street 2:SUITE 9
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-2766
Practice Address - Country:US
Practice Address - Phone:508-824-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA70400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ08189Medicare PIN