Provider Demographics
NPI:1033556998
Name:PERRINO, ERICA DAVIS (MD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:DAVIS
Last Name:PERRINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1005 HEALTH CENTER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-4693
Mailing Address - Country:US
Mailing Address - Phone:217-238-6055
Mailing Address - Fax:217-258-2216
Practice Address - Street 1:116 W BUCHANAN AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-2522
Practice Address - Country:US
Practice Address - Phone:217-345-7700
Practice Address - Fax:217-345-7200
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036138703207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine