=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972034130
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PERRY NAGIN MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2017
-----------------------------------------------------
Last Update Date | 06/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 PERRYRIDGE RD
-----------------------------------------------------
City | GREENWICH
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06830-4697
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 355-320-3863
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 173 EAST AVE
-----------------------------------------------------
City | NEW CANAAN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06840-5614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-972-4250
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 80120
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------