Provider Demographics
NPI:1649389602
Name:PERRY, DORA R (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DORA
Middle Name:R
Last Name:PERRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:DORA
Other - Middle Name:I
Other - Last Name:REDD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:937 DUNCAN AVE
Mailing Address - Street 2:
Mailing Address - City:YEADON
Mailing Address - State:PA
Mailing Address - Zip Code:19050-3706
Mailing Address - Country:US
Mailing Address - Phone:610-626-0476
Mailing Address - Fax:
Practice Address - Street 1:1400 BLACKHORSE HILL RD
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-2040
Practice Address - Country:US
Practice Address - Phone:610-384-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001011L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical