Provider Demographics
NPI:1699751131
Name:PERRON, ANGELA M (DPM)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:M
Last Name:PERRON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2690
Mailing Address - Country:US
Mailing Address - Phone:207-725-4008
Mailing Address - Fax:207-725-5749
Practice Address - Street 1:81 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 2100
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2690
Practice Address - Country:US
Practice Address - Phone:207-725-4008
Practice Address - Fax:207-725-5749
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD 1008213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME265980099Medicaid
ME0915250001Medicare NSC
MEU61550Medicare UPIN
MEMM6351Medicare ID - Type Unspecified