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General NPI Number Information
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NPI Number | 1295791598
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Entity Type | Individual
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Provider Name | PERIN W DIANA JR. MD
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Gender | Male
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 10/13/2016
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Provider Practice Location Address
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Address Line | 1000 PINE STREET
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City | VARNVILLE
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State | SC
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Zip | 29944-0969
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Country | US
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Telephone | 803-943-5228
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Fax | 803-943-4591
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Provider Business Mailing Address
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Address Line | 55 MERIDEN AVE STE 2D
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City | SOUTHINGTON
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State | CT
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Zip | 06489-3235
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Country | US
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Telephone | 843-726-6509
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Fax | 843-726-6809
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 20809
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License Number State | SC
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