Provider Demographics
NPI:1346231677
Name:FOREMAN, PERRY JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:JAY
Last Name:FOREMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2401 W BELVEDERE AVE
Mailing Address - Street 2:CREDENTIALING DEPT.
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5216
Mailing Address - Country:US
Mailing Address - Phone:410-601-5524
Mailing Address - Fax:410-601-8946
Practice Address - Street 1:MICHEL MIROWSKI, MD, OFF. BLDG
Practice Address - Street 2:5051 GREENSPRING AVENUE
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209
Practice Address - Country:US
Practice Address - Phone:410-601-9515
Practice Address - Fax:410-601-8905
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2007-11-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK77362084N0400X
MDD0649362084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCA8374OtherR/R MEDICARE GROUP #
MDP00370995OtherR/R MEDICARE PROVIDER #
MDS576P251Medicare PIN
MDCA8374OtherR/R MEDICARE GROUP #
MDP00370995OtherR/R MEDICARE PROVIDER #