Provider Demographics
NPI:1275543795
Name:PERRY, CHARLENE ROSETTA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:ROSETTA
Last Name:PERRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 MERLIN DR
Mailing Address - Street 2:
Mailing Address - City:BELCAMP
Mailing Address - State:MD
Mailing Address - Zip Code:21017-1539
Mailing Address - Country:US
Mailing Address - Phone:410-272-0530
Mailing Address - Fax:
Practice Address - Street 1:219 MERLIN DR
Practice Address - Street 2:
Practice Address - City:BELCAMP
Practice Address - State:MD
Practice Address - Zip Code:21017-1539
Practice Address - Country:US
Practice Address - Phone:410-272-0530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002988363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant