Healthcare Provider Details

I. General information

NPI: 1699751131
Provider Name (Legal Business Name): ANGELA M PERRON DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 03/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 MEDICAL CENTER DR SUITE 2100
BRUNSWICK ME
04011-2690
US

IV. Provider business mailing address

81 MEDICAL CENTER DR
BRUNSWICK ME
04011-2690
US

V. Phone/Fax

Practice location:
  • Phone: 207-725-4008
  • Fax: 207-725-5749
Mailing address:
  • Phone: 207-725-4008
  • Fax: 207-725-5749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPOD 1008
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: