=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952457707
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SCOTT PERRY PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3001 HOSPITAL DRIVE PRINCE GEORGE'S HOSPITAL CENTER
-----------------------------------------------------
City | CHEVERLY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20785
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-618-3779
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4108 BURRLAND RD
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23703-1908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-484-3790
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AS0400X
-----------------------------------------------------
Taxonomy Name | Surgical Physician Assistant
-----------------------------------------------------
License Number | C0003099
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------