Healthcare Provider Details

I. General information

NPI: 1336140706
Provider Name (Legal Business Name): JOHN H PERKINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 FARMINGTON AVE STE 3
WEST HARTFORD CT
06119-1418
US

IV. Provider business mailing address

901 FARMINGTON AVENUE STE 3
WEST HARTFORD CT
06119
US

V. Phone/Fax

Practice location:
  • Phone: 860-586-2111
  • Fax: 860-586-2114
Mailing address:
  • Phone: 860-586-2111
  • Fax: 860-586-2114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number017429
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: