Individual
KEVIN PERUSSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1001 SAM PERRY BLVD, FREDERICKSBURG, VA 22401-4453
(540) 361-1000
(540) 361-7010
Mailing address
10401 SPOTSYLVANIA AVE, SUITE 200, FREDERICKSBURG, VA 22408-8606
(540) 361-1000
(540) 361-7010
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
0101232437
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
54-0972713
TAX ID
—
01
—
54-1364028
TAX ID
—
Enumeration date
05/08/2006
Last updated
02/08/2016
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