Provider Demographics
NPI:1821109711
Name:PERRY, CHARLES M (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:M
Last Name:PERRY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1354 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725
Mailing Address - Country:US
Mailing Address - Phone:740-439-4600
Mailing Address - Fax:740-432-8712
Practice Address - Street 1:1354 CLARK ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725
Practice Address - Country:US
Practice Address - Phone:740-439-4600
Practice Address - Fax:740-432-8712
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002747213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPD6489Medicaid
OH480028648OtherRAILROAD MEDICARE
OH0852895Medicaid
OH0852895Medicaid
SCPD6489Medicaid