Provider Demographics
NPI:1720033541
Name:PERROTTA, VINCENT J (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:J
Last Name:PERROTTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:314 W CARROLL ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5305
Mailing Address - Country:US
Mailing Address - Phone:410-546-0464
Mailing Address - Fax:410-546-8529
Practice Address - Street 1:314 W CARROLL ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5305
Practice Address - Country:US
Practice Address - Phone:410-546-0464
Practice Address - Fax:410-546-8529
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD47270208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD828CMedicare PIN
DE000B07P29Medicare PIN
MDF76919Medicare UPIN