Healthcare Provider Details

I. General information

NPI: 1265549208
Provider Name (Legal Business Name): LINDA M PERRY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 05/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7604 CENTRAL AVE LOWER LEVEL
PHILADELPHIA PA
19111-2433
US

IV. Provider business mailing address

2450 W HUNTING PARK AVE
PHILADELPHIA PA
19129-1302
US

V. Phone/Fax

Practice location:
  • Phone: 215-214-3100
  • Fax: 215-214-3131
Mailing address:
  • Phone: 215-214-4199
  • Fax: 215-214-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA052510
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: