Provider Demographics
NPI:1922022516
Name:PEREIRA, AUDREY P (MD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:P
Last Name:PEREIRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26 TOWER PL
Mailing Address - Street 2:
Mailing Address - City:FANWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07023-1023
Mailing Address - Country:US
Mailing Address - Phone:908-410-7422
Mailing Address - Fax:732-729-0683
Practice Address - Street 1:317 GEORGE ST
Practice Address - Street 2:PRIMARY CARE - VAMC
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2008
Practice Address - Country:US
Practice Address - Phone:732-729-9555
Practice Address - Fax:732-729-0683
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA065845207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMA 065845OtherSTAE LICENCE NUMBER