Provider Demographics
NPI:1477514883
Name:PERKINS, ALVIN DALE (MD)
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:DALE
Last Name:PERKINS
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:PO BOX 3310
Mailing Address - Street 2:
Mailing Address - City:W SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42564
Mailing Address - Country:US
Mailing Address - Phone:606-678-8800
Mailing Address - Fax:606-679-5238
Practice Address - Street 1:305 LANGDON ST
Practice Address - Street 2:LAKE CUMBERLAND REGIONAL HOSPITAL
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501
Practice Address - Country:US
Practice Address - Phone:606-451-3154
Practice Address - Fax:606-679-5238
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28714207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6428714700Medicaid
1541001Medicare ID - Type Unspecified
KY6428714700Medicaid