Provider Demographics
NPI:1073755427
Name:PERUMAL, BALAJI (MD,)
Entity Type:Individual
Prefix:
First Name:BALAJI
Middle Name:
Last Name:PERUMAL
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22995 HIGHWAY 76 E
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-7529
Mailing Address - Country:US
Mailing Address - Phone:864-833-0038
Mailing Address - Fax:864-833-0520
Practice Address - Street 1:22995 HIGHWAY 76 E
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-7529
Practice Address - Country:US
Practice Address - Phone:864-833-0038
Practice Address - Fax:864-833-0520
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA262329207W00000X
NY267055207W00000X
SC51563207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400224322Medicare PIN
MAS400224323Medicare PIN