Provider Demographics
NPI:1528247657
Name:VINCENT E. PERKOWSKI, D.O., LLC
Entity type:Organization
Organization Name:VINCENT E. PERKOWSKI, D.O., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:E
Authorized Official - Last Name:PERKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-834-9761
Mailing Address - Street 1:3300 BAILEY ST NW
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-3613
Mailing Address - Country:US
Mailing Address - Phone:330-834-9761
Mailing Address - Fax:330-834-9765
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-6173207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2484422Medicaid
OH2484422Medicaid