Provider Demographics
NPI:1508193897
Name:NISEN, PERRY D (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:D
Last Name:NISEN
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Gender:M
Credentials:MD, PHD
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Mailing Address - Street 1:1250 S COLLEGEVILLE RD
Mailing Address - Street 2:UP1455
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-2990
Mailing Address - Country:US
Mailing Address - Phone:610-917-6754
Mailing Address - Fax:610-917-4181
Practice Address - Street 1:1250 S COLLEGEVILLE RD
Practice Address - Street 2:UP1455
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-2990
Practice Address - Country:US
Practice Address - Phone:610-917-6754
Practice Address - Fax:610-917-4181
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
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Provider Licenses
StateLicense IDTaxonomies
PAMD4275622080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology