Provider Demographics
NPI:1437116035
Name:PERRY, ANTHONY MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:MICHAEL
Last Name:PERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3 W OLIVE ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-2572
Mailing Address - Country:US
Mailing Address - Phone:570-969-9575
Mailing Address - Fax:570-969-1651
Practice Address - Street 1:3 W OLIVE ST
Practice Address - Street 2:SUITE 220
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-2572
Practice Address - Country:US
Practice Address - Phone:570-969-9575
Practice Address - Fax:570-969-1651
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017243E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00264712OtherRAILROAD MEDICARE
PA006123270008Medicaid
PAP00264712OtherRAILROAD MEDICARE
PAA38331Medicare UPIN