Provider Demographics
NPI:1740292564
Name:PERINCHERY, ANITHA MARY (MD)
Entity type:Individual
Prefix:MRS
First Name:ANITHA
Middle Name:MARY
Last Name:PERINCHERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANITHA
Other - Middle Name:MARY
Other - Last Name:JOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:101 W UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-3909
Mailing Address - Country:US
Mailing Address - Phone:217-366-1304
Mailing Address - Fax:217-366-7427
Practice Address - Street 1:101 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3909
Practice Address - Country:US
Practice Address - Phone:217-366-1304
Practice Address - Fax:217-366-7427
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226244-1207RC0000X
NY226244207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine