Provider Demographics
NPI:1346357480
Name:PERUSSE, PASCALE I (MD)
Entity Type:Individual
Prefix:
First Name:PASCALE
Middle Name:
Last Name:PERUSSE
Suffix:I
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 BELMONT ST
Mailing Address - Street 2:SUITE #103
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2657
Mailing Address - Country:US
Mailing Address - Phone:508-852-7200
Mailing Address - Fax:508-852-7201
Practice Address - Street 1:67 BELMONT ST
Practice Address - Street 2:SUITE #103
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2657
Practice Address - Country:US
Practice Address - Phone:508-852-7200
Practice Address - Fax:508-852-7201
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA57200207W00000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3017877Medicaid
A58660Medicare UPIN
MAV03658Medicare PIN
MAA58660Medicare UPIN