Provider Demographics
NPI:1568429330
Name:PERNA, ANTHONY F (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:F
Last Name:PERNA
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 1:1430 COLVIN BLVD
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14223-1440
Mailing Address - Country:US
Mailing Address - Phone:716-874-4060
Mailing Address - Fax:716-871-1198
Practice Address - Street 1:1430 COLVIN BLVD
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14223-1440
Practice Address - Country:US
Practice Address - Phone:716-874-4060
Practice Address - Fax:716-871-1198
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148393207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD66519Medicare UPIN
NYAA1715Medicare PIN