Provider Demographics
NPI:1679519516
Name:PERELLA, ANTHONY JOHN (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JOHN
Last Name:PERELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 SEMINOLE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2836
Mailing Address - Country:US
Mailing Address - Phone:321-637-2975
Mailing Address - Fax:321-433-1935
Practice Address - Street 1:1133 SEMINOLE DR
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2836
Practice Address - Country:US
Practice Address - Phone:321-637-2975
Practice Address - Fax:321-433-1935
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0064585207RP1001X
PAMD445533207RP1001X
FLME158653207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD411222900Medicaid
DE1000040239Medicaid
FL116451800Medicaid