Provider Demographics
NPI:1417248808
Name:PERUGINO, CORY ADAM (DO)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:ADAM
Last Name:PERUGINO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 BIGELOW ST
Mailing Address - Street 2:APT B
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-2302
Mailing Address - Country:US
Mailing Address - Phone:201-874-2168
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:YAWKEY 2C
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-7938
Practice Address - Fax:617-643-1274
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA264756207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology