Provider Demographics
NPI:1669467957
Name:PEREZ, RICARDO A (MD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:A
Last Name:PEREZ
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 1:409 S 2ND ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:717-231-8968
Mailing Address - Fax:
Practice Address - Street 1:1701 INNOVATION DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-8815
Practice Address - Country:US
Practice Address - Phone:717-843-8623
Practice Address - Fax:717-815-2489
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85720207R00000X, 208M00000X
PAMD433094207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269218000Medicaid
FL160095OtherPREFERRED CARE
FL51427OtherBCBS
FL608025500OtherBLACK LUNG FED PROGRAM
FL160095OtherPREFERRED CARE
FLH70139Medicare UPIN
FLP000142280Medicare ID - Type UnspecifiedRAILROAD