Provider Demographics
NPI:1114914223
Name:PERRY, KEVIN P (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:P
Last Name:PERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 SW CARY PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-5600
Mailing Address - Country:US
Mailing Address - Phone:919-467-3203
Mailing Address - Fax:919-459-5401
Practice Address - Street 1:110 KILDAIRE PARK DR STE 500
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8161
Practice Address - Country:US
Practice Address - Phone:919-467-3203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01319208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5908477Medicaid
NC820574614OtherTAX ID
NC2021751Medicare PIN
NC820574614OtherTAX ID