Provider Demographics
NPI:1891752135
Name:PERRY, MARK F (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:F
Last Name:PERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1185 SWEET HOME RD
Mailing Address - Street 2:ATTN: BETTY PICCILLO
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1018
Mailing Address - Country:US
Mailing Address - Phone:716-656-4250
Mailing Address - Fax:716-656-4074
Practice Address - Street 1:1185 SWEET HOME RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1018
Practice Address - Country:US
Practice Address - Phone:716-689-0040
Practice Address - Fax:716-568-2337
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY218400208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00026169002OtherUNIVERA #
NY1292784OtherIHA #
NY159656DLOtherPREFERRED CARE #
NY000528079002OtherHEALTH NOW BCBS # MM
NY000528079001OtherHEALTH NOW BCBS # WS
NY040426003127OtherFIDELIS #
NYJ400009953Medicare PIN
NY000528079001OtherHEALTH NOW BCBS # WS