Provider Demographics
NPI:1871695114
Name:PERDRIZET, GEORGE A (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:A
Last Name:PERDRIZET
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1290 SILAS DEANE HWY
Mailing Address - Street 2:HARTFORD HEALTHCARE-CVO
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4337
Mailing Address - Country:US
Mailing Address - Phone:860-972-9093
Mailing Address - Fax:860-972-7040
Practice Address - Street 1:100 GRAND STREET
Practice Address - Street 2:THE HOSPITAL OF CENTRAL CONNECTICUT
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-2016
Practice Address - Country:US
Practice Address - Phone:860-584-8379
Practice Address - Fax:860-584-8372
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT260172083P0011X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001260174Medicaid
CT001260174Medicaid
CT020001265Medicare ID - Type UnspecifiedFOR CLINIC C00814