Provider Demographics
NPI:1427184191
Name:CARTER-PERPALL, RENEE (DPM)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:
Last Name:CARTER-PERPALL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2138
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20718-2138
Mailing Address - Country:US
Mailing Address - Phone:301-805-9308
Mailing Address - Fax:301-805-9309
Practice Address - Street 1:4000 MITCHELLVILLE RD
Practice Address - Street 2:SUITE A304
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3133
Practice Address - Country:US
Practice Address - Phone:301-805-9308
Practice Address - Fax:301-805-9309
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2015-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00648213EP1101X
DCPO368213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
146236OtherMEDICARE PTAN
MD1125087 00Medicaid
MDT31205Medicare UPIN
5908280001Medicare NSC
MDT31205Medicare UPIN