Provider Demographics
NPI:1831502061
Name:PERAGINE, MATTHEW (MS ATC LAT PES CES)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:PERAGINE
Suffix:
Gender:M
Credentials:MS ATC LAT PES CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WINNING DR
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4776
Mailing Address - Country:US
Mailing Address - Phone:908-770-7182
Mailing Address - Fax:
Practice Address - Street 1:1 WINNING DR
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4776
Practice Address - Country:US
Practice Address - Phone:908-770-7182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAT0000845174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist