Healthcare Provider Details

I. General information

NPI: 1801855937
Provider Name (Legal Business Name): LINDA PAIGE D'ANDREA PERRIELLO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2006
Last Update Date: 10/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 E JEFFERSON ST
CHARLOTTESVILLE VA
22902-5354
US

IV. Provider business mailing address

1011 E JEFFERSON ST
CHARLOTTESVILLE VA
22902-5354
US

V. Phone/Fax

Practice location:
  • Phone: 434-296-9161
  • Fax: 434-977-6068
Mailing address:
  • Phone: 434-296-9161
  • Fax: 434-977-6068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD035705
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number228220
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101239307
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: