Provider Demographics
NPI:1891713269
Name:PERKINS, CONNIE (DO)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:
Last Name:PERKINS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RONCEVERTE
Mailing Address - State:WV
Mailing Address - Zip Code:24970-8016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1322 MAPLEWOOD AVE STE A
Practice Address - Street 2:
Practice Address - City:RONCEVERTE
Practice Address - State:WV
Practice Address - Zip Code:24970-8016
Practice Address - Country:US
Practice Address - Phone:304-647-1161
Practice Address - Fax:304-647-3006
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1710207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5472643OtherAETNA
WV649678001OtherCIGNA
WV035OtherMTST BCBS
WV119357OtherANTHEM BCBS
WV160046203OtherRAILROAD MEDICARE
WV114262OtherSOUTHERN HEALTH
WV273677OtherMAMSI
WV6200073000Medicaid
WVPE0886951Medicare ID - Type Unspecified
WV273677OtherMAMSI
WV649678001OtherCIGNA