Provider Demographics
NPI:1982688826
Name:PERRE, ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:PERRE
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 1:1331 E WYOMING AVE
Mailing Address - Street 2:SUITE 4040
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-3808
Mailing Address - Country:US
Mailing Address - Phone:215-537-7542
Mailing Address - Fax:215-537-7884
Practice Address - Street 1:1331 E WYOMING AVE
Practice Address - Street 2:SUITE 4040
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-3808
Practice Address - Country:US
Practice Address - Phone:215-537-7542
Practice Address - Fax:215-537-7884
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD060147L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
21198960001OtherKEYSTONE LIAISON
4708888939OtherFIRST HEALTH CCN
35061OtherINTERCOUNTY
1058223OtherKEYSTONE MERCY HEALTHPLAN
007302OtherAETNA PPO MANAGED CARE
PC0137OtherHEALTH NET
007302OtherAETNA HMO
2119896001OtherAMERIHEALTH ADMINISTRATOR
4708888939OtherDEVON
21198960001OtherKEYSTONE HEALTH EAST 65
2119896001OtherAMERIHEALTH HMO
47088939OtherMAMSI
P1134389OtherOXFORD
21198960001OtherKEYSTONE HEALTH PLAN EAST
P1134389OtherMULTI PLAN
35061OtherINTERCOUNTY
P1134389OtherMULTI PLAN