Individual
CHANNA PERERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
755 CAMPBELL AVE STE 3, WEST HAVEN, CT 06516-3715
(203) 937-1100
(203) 937-1102
Mailing address
755 CAMPBELL AVE STE 3, WEST HAVEN, CT 06516-3715
(203) 937-1100
(203) 937-1102
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036182
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00136823
—
CT
01
—
010036182CT01
ANTHEM BLUE SHIELD
CT
01
—
0V7493
HEALTHNET
CT
01
—
110194409
RAILROAD MEDICARE
CT
01
—
2026973
AETNA
CT
01
—
708711
CONNECTICARE
CT
01
—
P1013460
OXFORD
CT
Enumeration date
06/27/2005
Last updated
09/15/2011
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