Provider Demographics
NPI:1720197858
Name:PERME, CHARLES MCCRORY (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:MCCRORY
Last Name:PERME
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 1:2754 SOLUTION CTR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-2007
Mailing Address - Country:US
Mailing Address - Phone:606-864-9697
Mailing Address - Fax:916-533-0078
Practice Address - Street 1:2201 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2843
Practice Address - Country:US
Practice Address - Phone:606-408-4000
Practice Address - Fax:916-533-0078
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350639202085R0202X
KY304152085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000978917OtherANTHEM BCBS
KY64937030Medicaid
OH0991066Medicaid
OH300094914OtherRAILROAD MEDICARE
OH000000038020OtherANTHEM
OH300094914OtherRAILROAD MEDICARE
KY64937030Medicaid
KYK127721Medicare PIN