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NPI Code Detail

MEDICARE: DAVID ANTHONY PERNA PH.D.

MEDICARE: DAVID ANTHONY PERNA PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist7172MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1W05592OTHERMABLUE CROSS BLUE SHIELD MA
20004749OTHERMAVALUE OPTIONS UPS

General Provider Information

NPI Number : 1447460746
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID ANTHONY PERNA PH.D.
Provider Business Mailing Address
First Line : 44 THORNTON ST
Second Line :
City : NEWTON
State : MA
Zip : 02458-1532
Country : US
Telephone Number : 617-431-1441
Fax Number : 617-244-2774
Provider Business Practice Location Address
First Line : 44 THORNTON ST
Second Line :
City : NEWTON
State : MA
Zip : 02458-1532
Country : US
Telephone Number : 617-431-1441
Fax Number : 617-244-2774
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2007
Last Update Date : 02/18/2019

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