Provider Demographics
NPI:1831287614
Name:PERRY, JAMES OLIVER (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:OLIVER
Last Name:PERRY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 KNOLL NORTH DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2373
Mailing Address - Country:US
Mailing Address - Phone:410-964-6200
Mailing Address - Fax:410-964-6392
Practice Address - Street 1:5450 KNOLL NORTH DR
Practice Address - Street 2:SUITE 250
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2373
Practice Address - Country:US
Practice Address - Phone:410-964-6200
Practice Address - Fax:410-964-6392
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0000743363A00000X
CACA14918363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD234874ZDDB - 149619Medicare PIN
MD234873YVZ - 945LMedicare PIN