Healthcare Provider Details

I. General information

NPI: 1710943956
Provider Name (Legal Business Name): RENEE LYNN PERKIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 FOXHUNT DR
BEAR DE
19701-2538
US

IV. Provider business mailing address

PO BOX 151
NEW CASTLE DE
19720-0151
US

V. Phone/Fax

Practice location:
  • Phone: 302-652-2455
  • Fax: 302-322-6252
Mailing address:
  • Phone: 302-652-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0058324
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: