Provider Demographics
NPI:1972829687
Name:PERUMALSAMY, PRIYA DHARSHNI (MD)
Entity Type:Individual
Prefix:DR
First Name:PRIYA
Middle Name:DHARSHNI
Last Name:PERUMALSAMY
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 1:740 W FULTON ST
Mailing Address - Street 2:APT 811
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-5000
Mailing Address - Country:US
Mailing Address - Phone:201-562-3641
Mailing Address - Fax:
Practice Address - Street 1:1653 W CONGRESS PKWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3833
Practice Address - Country:US
Practice Address - Phone:312-947-0229
Practice Address - Fax:312-947-1620
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10833900207P00000X
IN01082572A207P00000X
IL036130862207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine