Individual
DR. PERIN W DIANA JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 PINE STREET, VARNVILLE, SC 29944-0969
(803) 943-5228
(803) 943-4591
Mailing address
55 MERIDEN AVE, STE 2D, SOUTHINGTON, CT 06489-3235
(843) 726-6509
(843) 726-6809
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
20809
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
570669239-001
BLUE CROSS
SC
01
—
570669239-002
BLUE CHOICE
SC
05
—
GP0365
—
SC
05
—
T49310
—
SC
Enumeration date
04/25/2006
Last updated
10/13/2016
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