Provider Demographics
NPI:1326141631
Name:PERRY, DAVID G (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:PERRY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 W JAMES ST
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-3623
Mailing Address - Country:US
Mailing Address - Phone:215-442-5500
Mailing Address - Fax:215-442-1641
Practice Address - Street 1:1006 W JAMES ST
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-3623
Practice Address - Country:US
Practice Address - Phone:215-442-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005315L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0372152000OtherBLUE SHIELD PERSONAL CHOI
PA554209OtherBLUE SHIELD HIGHMARK
PA1396488/02Medicaid
PA554209Medicare ID - Type Unspecified
PA1396488/02Medicaid