Healthcare Provider Details

I. General information

NPI: 1568502326
Provider Name (Legal Business Name): DAVID J. PERRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 05/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9105 FRANKLIN SQUARE DR SUITE 100
BALTIMORE MD
21237-3930
US

IV. Provider business mailing address

9105 FRANKLIN SQUARE DR SUITE 100
BALTIMORE MD
21237-3930
US

V. Phone/Fax

Practice location:
  • Phone: 410-682-6800
  • Fax: 410-682-2783
Mailing address:
  • Phone: 410-682-6800
  • Fax: 410-682-2783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0065782
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: