Provider Demographics
NPI:1699917898
Name:PERKOWSKI, KRISTY (DO)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:PERKOWSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 FORE RIVER PKWY
Mailing Address - Street 2:SUITE 160
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2780
Mailing Address - Country:US
Mailing Address - Phone:207-553-6767
Mailing Address - Fax:207-553-6749
Practice Address - Street 1:195 FORE RIVER PKWY
Practice Address - Street 2:SUITE 160
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2780
Practice Address - Country:US
Practice Address - Phone:207-553-6767
Practice Address - Fax:207-553-6749
Is Sole Proprietor?:No
Enumeration Date:2009-04-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263450208000000X
MEDO2490208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics