Provider Demographics
NPI:1336140706
Name:PERKINS, JOHN H (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:PERKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:901 FARMINGTON AVENUE
Mailing Address - Street 2:STE 3
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119
Mailing Address - Country:US
Mailing Address - Phone:860-586-2111
Mailing Address - Fax:860-586-2114
Practice Address - Street 1:901 FARMINGTON AVE
Practice Address - Street 2:STE 3
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1418
Practice Address - Country:US
Practice Address - Phone:860-586-2111
Practice Address - Fax:860-586-2114
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2010-02-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT017429207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001174291Medicaid
CT001174291Medicaid
CT040000129Medicare ID - Type Unspecified