Provider Demographics
NPI:1346296399
Name:PERONA, PHILIP STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:STEPHEN
Last Name:PERONA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1438 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2311
Mailing Address - Country:US
Mailing Address - Phone:419-230-2293
Mailing Address - Fax:
Practice Address - Street 1:2510 COMMONS BLVD STE 125
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-3835
Practice Address - Country:US
Practice Address - Phone:662-249-4728
Practice Address - Fax:937-558-3026
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35051486207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0618068Medicaid
OH0618068Medicaid
OHPR0807875Medicare PIN