Provider Demographics
NPI:1871643387
Name:PERRONE, VICTOR T (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:T
Last Name:PERRONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:40 MEDICAL PARK
Mailing Address - Street 2:SUITE 505
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6392
Mailing Address - Country:US
Mailing Address - Phone:304-243-4764
Mailing Address - Fax:304-243-0404
Practice Address - Street 1:40 MEDICAL PARK
Practice Address - Street 2:SUITE 505
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6392
Practice Address - Country:US
Practice Address - Phone:304-243-4764
Practice Address - Fax:304-243-0404
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV15735207R00000X
OH35060560207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0072105000Medicaid
OH0747802Medicaid
D98025Medicare UPIN
OH0632028Medicare ID - Type UnspecifiedINDIVIDUAL
WV0632027Medicare ID - Type UnspecifiedINDIVIDUAL