MEDICARE: MARK DONALD PERRY MD

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	207X00000X	Orthopaedic Surgery Physician	D42699	MD
2	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician	L1966	TX
3	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician	D42699	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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	51541964	OTHER	AL	BCBS - STANTON RD
5	51541965	OTHER	AL	BCBS- MEDICAL PARK DR
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437114402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK DONALD PERRY MD

Provider Business Mailing Address
First Line	:	23000 MOAKLEY ST STE 102
Second Line	:
City	:	LEONARDTOWN
State	:	MD
Zip	:	20650-2916
Country	:	US
Telephone Number	:	301-475-5555
Fax Number	:	301-475-5914

Provider Business Practice Location Address
First Line	:	23000 MOAKLEY ST STE 102
Second Line	:
City	:	LEONARDTOWN
State	:	MD
Zip	:	20650-2916
Country	:	US
Telephone Number	:	301-475-5555
Fax Number	:	301-475-5914

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

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	08/12/2021

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Directions to “ MARK DONALD PERRY MD” Practice Location

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