Healthcare Provider Details

I. General information

NPI: 1255260378
Provider Name (Legal Business Name): IAN JOHN PEREIRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 BEEKMAN ST
PLATTSBURGH NY
12901-1438
US

IV. Provider business mailing address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

V. Phone/Fax

Practice location:
  • Phone: 518-562-7100
  • Fax: 518-562-7531
Mailing address:
  • Phone: 802-847-2195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number343386
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: