Provider Demographics
NPI:1508885971
Name:PERLE, KRISTINE ELLEN (MD)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:ELLEN
Last Name:PERLE
Suffix:
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 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:9768 LIBERTY DR
Practice Address - Street 2:
Practice Address - City:PAINTED POST
Practice Address - State:NY
Practice Address - Zip Code:14870-9094
Practice Address - Country:US
Practice Address - Phone:607-937-4900
Practice Address - Fax:607-937-4940
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD061954L207Q00000X
NY252305207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016290240002Medicaid
NY03104267Medicaid
PA0016290240002Medicaid
PAG44286Medicare UPIN