1629062252 NPI number — CATHERINE V PERRY MD

Table of content: (NPI 1598961120)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629062252 NPI number — CATHERINE V PERRY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERRY
Provider First Name:
CATHERINE
Provider Middle Name:
V
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MYERS
Provider Other First Name:
CATHERINE
Provider Other Middle Name:
V.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629062252
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2320 8TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENCINITAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92024-6565
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-729-3946
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 SUNSET LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CULPEPER
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22701-3917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-829-4189
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  200200425 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 0101239862 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00417571 . This is a "RAILRAOD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1629062252 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 132MC . This is a "BCBS NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 303315 . This is a "BLUE SHIELD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 89132MC , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00012994 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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