Provider Demographics
NPI:1699723049
Name:PERROTTI, MARK ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ANTHONY
Last Name:PERROTTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 120188
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-0188
Mailing Address - Country:US
Mailing Address - Phone:203-481-0077
Mailing Address - Fax:203-481-0066
Practice Address - Street 1:251 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-4047
Practice Address - Country:US
Practice Address - Phone:203-481-0077
Practice Address - Fax:203-481-0066
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT207R00000X207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTG89788Medicare UPIN