Provider Demographics
NPI:1265456438
Name:PEREZ, ROGELIO (MD)
Entity Type:Individual
Prefix:
First Name:ROGELIO
Middle Name:
Last Name:PEREZ
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 1:2989 DIXWELL AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3501
Mailing Address - Country:US
Mailing Address - Phone:203-248-3013
Mailing Address - Fax:203-248-2878
Practice Address - Street 1:46 PRINCE ST
Practice Address - Street 2:SUITE 407
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1600
Practice Address - Country:US
Practice Address - Phone:203-777-2170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043514207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT043514OtherCONNECTICARE
CT010043514CT01OtherBLUE CROSS BLUE SHIELD
CT1087651OtherAETNA
CT2V7006OtherHEALTH NET
CT2V7006OtherHEALTH NET
CT043514OtherCONNECTICARE