Healthcare Provider Details

I. General information

NPI: 1295856169
Provider Name (Legal Business Name): PERRY PEDIATRICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 CENTRE DR
NEW BLOOMFIELD PA
17068-9675
US

IV. Provider business mailing address

PO BOX 356
NEW BLOOMFIELD PA
17068-0356
US

V. Phone/Fax

Practice location:
  • Phone: 717-582-2181
  • Fax: 717-582-3434
Mailing address:
  • Phone: 717-582-2181
  • Fax: 717-582-3434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD038287L
License Number StatePA

VIII. Authorized Official

Name: DR. BYUNG D. CHANG
Title or Position: CEO
Credential: M.D.
Phone: 717-582-2181