Provider Demographics
NPI:1659682227
Name:PERRIN, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:PERRIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6525 BELCREST RD STE 220
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2074
Mailing Address - Country:US
Mailing Address - Phone:301-779-7525
Mailing Address - Fax:301-779-4997
Practice Address - Street 1:6525 BELCREST RD STE 220
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2074
Practice Address - Country:US
Practice Address - Phone:301-779-7525
Practice Address - Fax:301-779-4997
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003946363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant