Provider Demographics
NPI:1790792158
Name:PERKS, KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:PERKS
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 1:34 DALE ROAD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06019
Mailing Address - Country:US
Mailing Address - Phone:860-676-1111
Mailing Address - Fax:860-676-0134
Practice Address - Street 1:34 DALE RD
Practice Address - Street 2:SUITE 205
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3659
Practice Address - Country:US
Practice Address - Phone:860-676-1111
Practice Address - Fax:860-676-0134
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036936208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics