Provider Demographics
NPI:1548214141
Name:PERRY, KEITH A (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:A
Last Name:PERRY
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 1:14 CEDAR SWAMP RD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02917-2448
Mailing Address - Country:US
Mailing Address - Phone:401-231-0060
Mailing Address - Fax:401-231-0064
Practice Address - Street 1:14 CEDAR SWAMP RD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917-2448
Practice Address - Country:US
Practice Address - Phone:401-231-0060
Practice Address - Fax:401-231-0064
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD07817208VP0000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7002962Medicaid
007002962Medicare ID - Type Unspecified