Healthcare Provider Details

I. General information

NPI: 1417248808
Provider Name (Legal Business Name): CORY ADAM PERUGINO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST YAWKEY 2C
BOSTON MA
02114-2621
US

IV. Provider business mailing address

28 BIGELOW ST APT B
CAMBRIDGE MA
02139-2302
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-7938
  • Fax: 617-643-1274
Mailing address:
  • Phone: 201-874-2168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number264756
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: