MEDICARE: PERRY & BARRON ORTHOPEDICS & SPORTS MEDICINE, PA

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	174400000X	Specialist	26968	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891717476
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERRY & BARRON ORTHOPEDICS & SPORTS MEDICINE, PA

Provider Business Mailing Address
First Line	:	2826 RANDOLPH RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1019
Country	:	US
Telephone Number	:	704-358-0308
Fax Number	:

Provider Business Practice Location Address
First Line	:	2826 RANDOLPH RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1019
Country	:	US
Telephone Number	:	704-358-0308
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GLENN BRADFORD PERRY
Credential	:	M.D.
Telephone Number	:	704-358-0308

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	08/22/2020

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