Provider Demographics
NPI:1174768147
Name:PERRIN, MARK (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:PERRIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:914 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-4404
Mailing Address - Country:US
Mailing Address - Phone:973-579-5218
Mailing Address - Fax:973-940-8938
Practice Address - Street 1:914 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-4404
Practice Address - Country:US
Practice Address - Phone:973-579-5218
Practice Address - Fax:973-940-8938
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02097600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine