Healthcare Provider Details

I. General information

NPI: 1356328116
Provider Name (Legal Business Name): GERREN SHINAR PERRY-FABRIZIO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GERREN SHINAR PERRY

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 FORT MEADE RD SUITE 109
LAUREL MD
20724
US

IV. Provider business mailing address

9910 FRANKLIN SQUARE DR # 2110
BALTIMORE MD
21236-4902
US

V. Phone/Fax

Practice location:
  • Phone: 301-317-8660
  • Fax: 301-317-8663
Mailing address:
  • Phone: 410-933-5412
  • Fax: 410-933-1390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0059182
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: