Provider Demographics
NPI:1912962440
Name:PERA, VINCENT (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:PERA
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 1:47 DANIELSON PIKE
Mailing Address - Street 2:
Mailing Address - City:NORTH SCITUATE
Mailing Address - State:RI
Mailing Address - Zip Code:02857-1892
Mailing Address - Country:US
Mailing Address - Phone:401-258-5419
Mailing Address - Fax:401-296-3995
Practice Address - Street 1:1170 PONTIAC AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-7944
Practice Address - Country:US
Practice Address - Phone:401-895-9937
Practice Address - Fax:401-296-3998
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD06964207RB0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI007008519OtherMEDICARE ID-TYPE UNSPECIFIED
RI6411-4OtherBCBS MIRIAM
RIP00434710OtherMEDICARE RAILROAD
RI21366-8OtherBLUE CROSS
RI7008519Medicaid
RI202587OtherBLUE CHIP
RI1104801349OtherBUTLER HOSPITAL NPI
RI1093831646OtherBUTLER HOSPITAL PROFESSIONAL BILLING OFFICE
RI6411-4OtherBCBS MIRIAM
C89852Medicare UPIN