Provider Demographics
NPI:1982666863
Name:PERRYO MEDICAL CENTER, P C
Entity Type:Organization
Organization Name:PERRYO MEDICAL CENTER, P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT -OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANATKUMAR
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHROFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-736-0443
Mailing Address - Street 1:PO BOX 646
Mailing Address - Street 2:
Mailing Address - City:PERRYOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15473-0646
Mailing Address - Country:US
Mailing Address - Phone:724-736-0443
Mailing Address - Fax:724-736-0454
Practice Address - Street 1:405 LIBERTY STREET
Practice Address - Street 2:
Practice Address - City:PERRYOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15473-0646
Practice Address - Country:US
Practice Address - Phone:724-736-0443
Practice Address - Fax:724-736-0454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049150L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA108389Medicare PIN
PA018532Medicare ID - Type UnspecifiedGROUP ID FOR CORPORATION