Provider Demographics
NPI:1831140730
Name:PEREZ, MARITZA I (MD)
Entity Type:Individual
Prefix:MS
First Name:MARITZA
Middle Name:I
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 PINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-5409
Mailing Address - Country:US
Mailing Address - Phone:203-972-7546
Mailing Address - Fax:203-972-5937
Practice Address - Street 1:39 PINE ST
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-5409
Practice Address - Country:US
Practice Address - Phone:203-972-7546
Practice Address - Fax:203-972-5937
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027844207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001278449Medicaid
CTD400111310Medicare PIN
D88731Medicare UPIN
CT001278449Medicaid