Provider Demographics
NPI:1013975325
Name:PERRICONE, DAVID M (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:PERRICONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2561 LAC DE VILLE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618
Mailing Address - Country:US
Mailing Address - Phone:585-473-3900
Mailing Address - Fax:585-461-2216
Practice Address - Street 1:2561 LAC DE VILLE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618
Practice Address - Country:US
Practice Address - Phone:585-473-3900
Practice Address - Fax:585-461-2216
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2013-06-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY173364208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics