Provider Demographics
NPI:1326007030
Name:PERRY, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:PERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:NIAGARA RADIOLOGISTS P C
Mailing Address - Street 2:PO BOX 8000, DEPT. 194
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14267-0001
Mailing Address - Country:US
Mailing Address - Phone:716-692-2160
Mailing Address - Fax:716-692-4342
Practice Address - Street 1:621 10TH ST
Practice Address - Street 2:NIAGAR RADIOLOGISTS, PC
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-1813
Practice Address - Country:US
Practice Address - Phone:716-278-4000
Practice Address - Fax:716-692-4342
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1388352085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00709691Medicaid
NYE72715Medicare PIN
NYE15486Medicare UPIN