Provider Demographics
NPI:1710930805
Name:PERRY, RICHARD GROVER (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:GROVER
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 1:233 E ALDER ST STE A
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-1513
Mailing Address - Country:US
Mailing Address - Phone:301-616-6042
Mailing Address - Fax:
Practice Address - Street 1:233 E ALDER ST STE A
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-1513
Practice Address - Country:US
Practice Address - Phone:301-616-6042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0031408207P00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD364831100Medicaid
849M548FMedicare ID - Type Unspecified
MD364831100Medicaid