Provider Demographics
NPI:1720305972
Name:PEROTTO, SAMUEL MARK II
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:MARK
Last Name:PEROTTO
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 ELM ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2300
Mailing Address - Country:US
Mailing Address - Phone:508-269-1205
Mailing Address - Fax:
Practice Address - Street 1:70 ELM ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2300
Practice Address - Country:US
Practice Address - Phone:508-269-1205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator