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General NPI Number Information
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NPI Number | 1225029762
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Entity Type | Individual
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Provider Name | DIANA VANESSA PERRY MD
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Gender | Female
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Dates
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Enumeration Date | 11/03/2005
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Last Update Date | 02/23/2015
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Provider Practice Location Address
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Address Line | 55 FOGG ROAD SOUTH SHORE MEDICAL CENTER
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City | SOUTH WEYMOUTH
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State | MA
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Zip | 02190
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Country | US
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Telephone | 781-340-8373
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Fax | 781-340-3699
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Provider Business Mailing Address
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Address Line | 9 CORTLAND DR
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City | SHARON
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State | MA
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Zip | 02067-3311
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Country | US
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Telephone | 781-718-4934
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 155376
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License Number State | MA
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