MEDICARE: MR. JAMES OLIVER PERRY P.A.-C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	C0000743	MD
2	363A00000X	Physician Assistant	CA14918	CA

General Provider Information

NPI Number	:	1831287614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES OLIVER PERRY P.A.-C.

Provider Business Mailing Address
First Line	:	5450 KNOLL NORTH DR
Second Line	:	SUITE 250
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2373
Country	:	US
Telephone Number	:	410-964-6200
Fax Number	:	410-964-6392

Provider Business Practice Location Address
First Line	:	5450 KNOLL NORTH DR
Second Line	:	SUITE 250
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2373
Country	:	US
Telephone Number	:	410-964-6200
Fax Number	:	410-964-6392

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	10/18/2012

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