Provider Demographics
NPI:1285626119
Name:PERAZZELLI, MICHAEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:PERAZZELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4 PALISADES DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1443
Mailing Address - Country:US
Mailing Address - Phone:518-458-1245
Mailing Address - Fax:518-458-1398
Practice Address - Street 1:4 PALISADES DR
Practice Address - Street 2:SUITE 150
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1443
Practice Address - Country:US
Practice Address - Phone:518-458-1245
Practice Address - Fax:518-458-1398
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY149769207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00790363Medicaid
NYRA2969Medicare PIN
NY00790363Medicaid