Healthcare Provider Details

I. General information

NPI: 1326007030
Provider Name (Legal Business Name): MARK PERRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 08/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 10TH ST NIAGAR RADIOLOGISTS, PC
NIAGARA FALLS NY
14301-1813
US

IV. Provider business mailing address

NIAGARA RADIOLOGISTS P C PO BOX 8000, DEPT. 194
BUFFALO NY
14267-0001
US

V. Phone/Fax

Practice location:
  • Phone: 716-278-4000
  • Fax: 716-692-4342
Mailing address:
  • Phone: 716-692-2160
  • Fax: 716-692-4342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number138835
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: