MEDICARE: PERRY & BARRON ORTHOPEDICS & SPORTS MEDICINE PA

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	107239	NC

General Provider Information

NPI Number	:	1619949864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERRY & BARRON ORTHOPEDICS & SPORTS MEDICINE PA

Provider Business Mailing Address
First Line	:	2826 RANDOLPH RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211
Country	:	US
Telephone Number	:	704-358-0308
Fax Number	:	704-358-0039

Provider Business Practice Location Address
First Line	:	2826 RANDOLPH RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211
Country	:	US
Telephone Number	:	704-358-0308
Fax Number	:	704-358-0039

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GLENN B PERRY
Credential	:
Telephone Number	:	704-358-0308

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	08/22/2020

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