Provider Demographics
NPI:1841238045
Name:PERINI, MICHAEL A (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:PERINI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2500 RADSTOCK RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-3820
Mailing Address - Country:US
Mailing Address - Phone:804-677-5936
Mailing Address - Fax:804-893-7801
Practice Address - Street 1:1230 ALVERSER DR STE 102
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2653
Practice Address - Country:US
Practice Address - Phone:804-677-5936
Practice Address - Fax:804-893-7801
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2025-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101230768207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAS865727Medicaid
VAS865727Medicaid
VA00V218V16Medicare PIN