Provider Demographics
NPI:1639280555
Name:PERROTTO, JOSEPH L JR (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:PERROTTO
Suffix:JR
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 1:886 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3466
Mailing Address - Country:US
Mailing Address - Phone:781-769-4682
Mailing Address - Fax:781-769-9272
Practice Address - Street 1:886 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3466
Practice Address - Country:US
Practice Address - Phone:781-769-4682
Practice Address - Fax:781-769-9272
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA32767207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA032767OtherTUFTS HEALTH PLAN
MA110033689AMedicaid
MA100003534OtherRAIL RAOD MEDICARE
MA30080OtherHARVARD PILGRIM HEALTH
MAM07823OtherBC/BS OF MASS
MA30080OtherHAVARD PILGRIM HEALTH CARE
MA30080OtherHAVARD PILGRIM HEALTH CARE
MAB75670Medicare UPIN