Provider Demographics
NPI:1740379932
Name:PERONE, NICOLA (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLA
Middle Name:
Last Name:PERONE
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 1:1631 NORTH LOOP W
Mailing Address - Street 2:560
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1500
Mailing Address - Country:US
Mailing Address - Phone:713-868-1168
Mailing Address - Fax:713-868-1179
Practice Address - Street 1:1631 NORTH LOOP W
Practice Address - Street 2:560
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1500
Practice Address - Country:US
Practice Address - Phone:713-868-1168
Practice Address - Fax:713-868-1179
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7781207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00N874Medicare ID - Type Unspecified
TXB25461Medicare UPIN