Healthcare Provider Details

I. General information

NPI: 1124274816
Provider Name (Legal Business Name): EUGENE FRANCIS PEREIRA MT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MOHEGAN AVE USCGA MEDICAL
NEW LONDON CT
06320-4195
US

IV. Provider business mailing address

15 MOHEGAN AVE USCGA MEDICAL
NEW LONDON CT
06320-4195
US

V. Phone/Fax

Practice location:
  • Phone: 860-701-6904
  • Fax: 860-444-8413
Mailing address:
  • Phone: 860-701-6904
  • Fax: 860-444-8413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number146627
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: