1699917898 NPI number — KRISTY PERKOWSKI DO

Table of content: KRISTY PERKOWSKI DO (NPI 1699917898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699917898 NPI number — KRISTY PERKOWSKI DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERKOWSKI
Provider First Name:
KRISTY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699917898
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
195 FORE RIVER PKWY
Provider Second Line Business Mailing Address:
SUITE 160
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04102-2780
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-553-6767
Provider Business Mailing Address Fax Number:
207-553-6749

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
195 FORE RIVER PKWY
Provider Second Line Business Practice Location Address:
SUITE 160
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04102-2780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-553-6767
Provider Business Practice Location Address Fax Number:
207-553-6749
Provider Enumeration Date:
04/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  263450 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: DO2490 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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