Provider Demographics
NPI:1477526184
Name:ROY, PERRY (MD)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:
Last Name:ROY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 S SHARON AMITY RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2978
Mailing Address - Country:US
Mailing Address - Phone:704-900-0252
Mailing Address - Fax:980-636-6518
Practice Address - Street 1:309 S SHARON AMITY RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2978
Practice Address - Country:US
Practice Address - Phone:704-900-0252
Practice Address - Fax:980-636-6518
Is Sole Proprietor?:No
Enumeration Date:2006-02-12
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9701136207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8911119Medicaid
SCN001136Medicaid
SCN001136Medicaid
NC8911119Medicaid
NC8911119Medicaid