Provider Demographics
NPI:1508808981
Name:PRELLOP, PERRI (MD)
Entity Type:Individual
Prefix:DR
First Name:PERRI
Middle Name:
Last Name:PRELLOP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4809 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-8800
Mailing Address - Country:US
Mailing Address - Phone:337-769-8660
Mailing Address - Fax:337-769-8661
Practice Address - Street 1:4809 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-8800
Practice Address - Country:US
Practice Address - Phone:337-769-8660
Practice Address - Fax:337-769-8661
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2007362085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4K170DX68OtherPERRI PRELLOP MEDICARE PTAN EFFECTIVE 05/19/2012
LA5DX68OtherONCOLOGICS LLC GROUP MEDICARE PTAN EFFECTIVE 05/19/2012
LA1043257Medicaid
LA329548ZLACOtherMEDICARE GROUP MEMBER PTAN FOR ACADIANA RADIATION THERAPY, LLC
LA200736OtherLOUISIANA MEDICAL LICENSE