Provider Demographics
NPI:1811009715
Name:PERRONA, ANTHONY PAUL (COA/L)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:PAUL
Last Name:PERRONA
Suffix:
Gender:M
Credentials:COA/L
Other - Prefix:MR
Other - First Name:ANTHONY
Other - Middle Name:P
Other - Last Name:PERRONA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1100 S CLINTON AVENUE
Mailing Address - Street 2:STE C
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334
Mailing Address - Country:US
Mailing Address - Phone:910-892-0027
Mailing Address - Fax:910-892-0029
Practice Address - Street 1:1100 S CLINTON AVENUE
Practice Address - Street 2:STE C
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334
Practice Address - Country:US
Practice Address - Phone:910-892-0027
Practice Address - Fax:910-892-0029
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3467235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC721634Medicaid
346639Medicare ID - Type Unspecified