Provider Demographics
NPI:1295856169
Name:PERRY PEDIATRICS, P.C.
Entity Type:Organization
Organization Name:PERRY PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BYUNG
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-582-2181
Mailing Address - Street 1:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:NEW BLOOMFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:17068-0356
Mailing Address - Country:US
Mailing Address - Phone:717-582-2181
Mailing Address - Fax:717-582-3434
Practice Address - Street 1:106 CENTRE DR
Practice Address - Street 2:
Practice Address - City:NEW BLOOMFIELD
Practice Address - State:PA
Practice Address - Zip Code:17068-9675
Practice Address - Country:US
Practice Address - Phone:717-582-2181
Practice Address - Fax:717-582-3434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038287L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC31704Medicare UPIN