1881381945 NPI number — VICTORIA ROSE PERUSKI DO

Table of content: VICTORIA ROSE PERUSKI DO (NPI 1881381945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881381945 NPI number — VICTORIA ROSE PERUSKI DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERUSKI
Provider First Name:
VICTORIA
Provider Middle Name:
ROSE
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:
PERUSKI
Provider Other First Name:
VICTORIA
Provider Other Middle Name:
ROSE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1881381945
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24035 TIMBER CREEK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROWNSTOWN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48134-8013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-493-2288
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CAMC BEHAVIORAL MEDICINE & PSYCHIATRY
Provider Second Line Business Practice Location Address:
3200 MACCORKLE AVE SE
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-388-1000
Provider Business Practice Location Address Fax Number:
304-388-1041
Provider Enumeration Date:
04/19/2023

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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