Provider Demographics
NPI:1356328116
Name:PERRY-FABRIZIO, GERREN SHINAR (MD)
Entity Type:Individual
Prefix:DR
First Name:GERREN
Middle Name:SHINAR
Last Name:PERRY-FABRIZIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GERREN
Other - Middle Name:SHINAR
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9910 FRANKLIN SQUARE DR # 2110
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4902
Mailing Address - Country:US
Mailing Address - Phone:410-933-5412
Mailing Address - Fax:410-933-1390
Practice Address - Street 1:3450 FORT MEADE RD
Practice Address - Street 2:SUITE 109
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724
Practice Address - Country:US
Practice Address - Phone:301-317-8660
Practice Address - Fax:301-317-8663
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0059182207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD024205501Medicaid
DC037324200Medicaid
MD024205501Medicaid
MD158PMedicare ID - Type UnspecifiedGROUP NUMBER
DC037324200Medicaid