Healthcare Provider Details

I. General information

NPI: 1750039186
Provider Name (Legal Business Name): MARK CHESTER PERKOWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 QUARRY RD # MC5660
PALO ALTO CA
94304-1419
US

IV. Provider business mailing address

453 QUARRY RD # MC5660
PALO ALTO CA
94304-1419
US

V. Phone/Fax

Practice location:
  • Phone: 650-498-7351
  • Fax:
Mailing address:
  • Phone: 650-498-7351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA209715
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberA209715
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125.081346
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: