Healthcare Provider Details

I. General information

NPI: 1770996621
Provider Name (Legal Business Name): DAVID MARK PERRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 FOLLY ROAD BLVD
CHARLESTON SC
29407-7507
US

IV. Provider business mailing address

48 FOLLY ROAD BLVD
CHARLESTON SC
29407-7507
US

V. Phone/Fax

Practice location:
  • Phone: 843-769-2100
  • Fax:
Mailing address:
  • Phone: 843-769-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number36991
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number36991
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: