Provider Demographics
NPI: | 1255326526 |
---|---|
Name: | PERKIN, RONALD M (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | RONALD |
Middle Name: | M |
Last Name: | PERKIN |
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: | PO BOX 751069 |
Mailing Address - Street 2: | |
Mailing Address - City: | CHARLOTTE |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28275-1069 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 252-744-3253 |
Mailing Address - Fax: | 252-744-3194 |
Practice Address - Street 1: | 600 MOYE BLVD |
Practice Address - Street 2: | ECU PHYSICIANS PEDIATRICS CRITICAL CARE |
Practice Address - City: | GREENVILLE |
Practice Address - State: | NC |
Practice Address - Zip Code: | 27834-4300 |
Practice Address - Country: | US |
Practice Address - Phone: | 252-744-5437 |
Practice Address - Fax: | 252-744-1514 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-09-13 |
Last Update Date: | 2011-12-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 200000579 | 2080P0203X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2080P0203X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NC | 89126GR | Medicaid | |
NC | 370017601 | Other | RAILROAD MEDICARE |
NC | 126GR | Other | BCBS NC |
NC | A88174 | Medicare UPIN | |
NC | 2280526B | Medicare PIN |