Healthcare Provider Details

I. General information

NPI: 1881381945
Provider Name (Legal Business Name): VICTORIA ROSE PERUSKI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICTORIA ROSE PERUSKI DO

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 04/19/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CAMC BEHAVIORAL MEDICINE & PSYCHIATRY 3200 MACCORKLE AVE SE
CHARLESTON WV
25304
US

IV. Provider business mailing address

24035 TIMBER CREEK LN
BROWNSTOWN MI
48134-8013
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-1000
  • Fax: 304-388-1041
Mailing address:
  • Phone: 734-493-2288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: