MEDICARE: DR. GERREN SHINAR PERRY-FABRIZIO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	D0059182	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356328116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERREN SHINAR PERRY-FABRIZIO M.D.

Provider Business Mailing Address
First Line	:	9910 FRANKLIN SQUARE DR # 2110
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21236-4902
Country	:	US
Telephone Number	:	410-933-5412
Fax Number	:	410-933-1390

Provider Business Practice Location Address
First Line	:	3450 FORT MEADE RD
Second Line	:	SUITE 109
City	:	LAUREL
State	:	MD
Zip	:	20724
Country	:	US
Telephone Number	:	301-317-8660
Fax Number	:	301-317-8663

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	05/29/2018

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